Provider Demographics
NPI:1174397822
Name:BROOKS, LACASTA D
Entity type:Individual
Prefix:MS
First Name:LACASTA
Middle Name:D
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 1:6790 STARKENBURG LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5308
Mailing Address - Country:US
Mailing Address - Phone:901-237-6258
Mailing Address - Fax:
Practice Address - Street 1:6790 STARKENBURG LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5308
Practice Address - Country:US
Practice Address - Phone:901-237-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174H00000XOther Service ProvidersHealth Educator