Active NPI
Kelvin Brooks
- Family Nurse Practitioner
- Columbia, SC
National Provider Identifier
1396349015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 30042
- Practice address
- 1601 Greene St
Columbia, SC 29208-4001 - Phone
- (803) 413-6483
- NPI assigned
- Nov 23, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 210674 | SC | |
| Family Nurse Practitioner | 363LF0000X | 30042 | SC | Primary |
Addresses
Primary practice location
1601 Greene St
Columbia, SC 29208-4001
Mailing address
1601 Greene St
Columbia, SC 29208-4001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210674 | SC | MD | General Practice Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Molina Care Connections, LLC. | Current | Accepting new patients |
Locations
200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666
4105 Faber Place Dr
Ste 120
North Charleston, SC 29405
Phone (562) 549-3966
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1396349015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 GREENE ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292084001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 GREENE ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292084001",
"telephone_number": "803-413-6483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "KELVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-23",
"last_updated": "2025-07-17",
"certification_date": "2025-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "SC",
"license": "210674",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "30042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.