Provider Demographics
NPI:1669207072
Name:BROOKS, OKECHI CHIZARAEKPERE
Entity type:Individual
Prefix:
First Name:OKECHI
Middle Name:CHIZARAEKPERE
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 1:405 ANTHONY CV
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-4510
Mailing Address - Country:US
Mailing Address - Phone:601-327-5239
Mailing Address - Fax:
Practice Address - Street 1:405 ANTHONY CV
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-4510
Practice Address - Country:US
Practice Address - Phone:601-327-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS921309163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical