Provider Demographics
NPI:1730452004
Name:BROOKS, WHITNEY R (NNP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:R
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NNP
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 843225
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3225
Mailing Address - Country:US
Mailing Address - Phone:813-262-8160
Mailing Address - Fax:813-891-9066
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5318
Practice Address - Fax:573-331-5087
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15665363LN0005X
MO2012039968363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN15665OtherLICENSE