Individual
MS. BETHANY MARIE BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3015 N BALLAS RD, DEPT RADIOLOGY, SAINT LOUIS, MO 63131-2329
(314) 996-5170
(314) 996-4261
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 996-5170
(314) 996-4261
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021017924
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220097215
—
MO
Enumeration date
04/01/2021
Last updated
05/02/2025
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