Provider Demographics
NPI:1396445888
Name:BROOKS, CHANTELL MARIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHANTELL
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1309 COFFEEN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5777
Mailing Address - Country:US
Mailing Address - Phone:888-832-2122
Mailing Address - Fax:888-599-4119
Practice Address - Street 1:4229 HUNT DR APT 4102
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-3262
Practice Address - Country:US
Practice Address - Phone:888-832-2122
Practice Address - Fax:888-599-4119
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily