Provider Demographics
NPI:1356487508
Name:BROOKS, SANDRA (BS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 AMY LN
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8056
Mailing Address - Country:US
Mailing Address - Phone:870-793-8925
Mailing Address - Fax:
Practice Address - Street 1:1800 MYERS ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7344
Practice Address - Country:US
Practice Address - Phone:870-793-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator