Provider Demographics
NPI:1881472546
Name:BROOKS, MELISSA J
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19320 E ADMIRAL PL STE 8
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3239
Mailing Address - Country:US
Mailing Address - Phone:918-340-5503
Mailing Address - Fax:
Practice Address - Street 1:19320 E ADMIRAL PL STE 8
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3239
Practice Address - Country:US
Practice Address - Phone:918-340-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator