Provider Demographics
NPI:1831686831
Name:BROOKS, ALLI KRISTEN (PA-C)
Entity type:Individual
Prefix:
First Name:ALLI
Middle Name:KRISTEN
Last Name:BROOKS
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 1:50 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6514
Mailing Address - Country:US
Mailing Address - Phone:479-619-7719
Mailing Address - Fax:
Practice Address - Street 1:50 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-6514
Practice Address - Country:US
Practice Address - Phone:479-619-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2018-023363A00000X
CA55256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty