Provider Demographics
NPI:1982379640
Name:BROOKS, CHANDLER DYAN (FNP)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:DYAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29343
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2045
Mailing Address - Country:US
Mailing Address - Phone:903-232-8290
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:802 MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5207
Practice Address - Country:US
Practice Address - Phone:903-757-6042
Practice Address - Fax:903-232-6261
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX900527163W00000X
TX1054521363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner