Provider Demographics
NPI:1770554578
Name:BROOKS, KIM CHEREE (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:CHEREE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2967
Mailing Address - Country:US
Mailing Address - Phone:423-492-7100
Mailing Address - Fax:423-492-8801
Practice Address - Street 1:1621 W MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2967
Practice Address - Country:US
Practice Address - Phone:423-492-7100
Practice Address - Fax:423-492-8801
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8988236Medicaid
D7120OtherMEDCOST
TNQ031807Medicaid
NC1770554578Medicaid
88236OtherNCBCBS
88236OtherNCBCBS
NCNCC092BMedicare PIN
2223898CMedicare PIN