Provider Demographics
NPI:1952874620
Name:BROOKS, KATHLEEN A (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:307 LAKE SIDE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2293
Mailing Address - Country:US
Mailing Address - Phone:478-973-8048
Mailing Address - Fax:
Practice Address - Street 1:199 FRONTIER PARK DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3963
Practice Address - Country:US
Practice Address - Phone:636-379-5934
Practice Address - Fax:636-410-3323
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017002506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily