Provider Demographics
NPI:1164153995
Name:BROOKS, TREZESTYVETTE
Entity type:Individual
Prefix:
First Name:TREZESTYVETTE
Middle Name:
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:PO BOX 1923
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0022
Mailing Address - Country:US
Mailing Address - Phone:978-902-1339
Mailing Address - Fax:
Practice Address - Street 1:7773 CAPITAL PEAK LN W APT 104
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-1556
Practice Address - Country:US
Practice Address - Phone:978-902-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy