Provider Demographics
NPI:1750400636
Name:BROOKER, LOUISE MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:MARIE
Last Name:BROOKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 CORNELL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5800
Mailing Address - Country:US
Mailing Address - Phone:806-355-6552
Mailing Address - Fax:806-468-0340
Practice Address - Street 1:4514 CORNELL ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5800
Practice Address - Country:US
Practice Address - Phone:806-355-6552
Practice Address - Fax:806-468-0340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00898207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8047M0OtherBLUECROSS BLUESHIELD
TX4557060001OtherPALMETTO GBA
TX4557060001OtherPALMETTO GBA
TXP14510Medicare UPIN