Individual provider Active NPI

Kelvin Brooks

  • Family Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1396349015
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
30042 Issued in SC
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

Updated by the provider on Jul 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250807003932 SC Practitioner - Nurse Practitioner 3779081948 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
210674SCMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Molina Care Connections, LLC. CurrentSince Jul 28, 2025 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

Verify at the official NPI Registry.