Holly J Brooks, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

1108222 Issued in TX

Practice address

27TH Special Operations Medical Group
224 W. D.L. Ingram Avenue, BLDG. 1408
Cannon Afb, NM 88103

Phone

(575) 784-2778

NPI assigned

Jul 1, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Holly Jo Bolt Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1538058722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27TH SPECIAL OPERATIONS MEDICAL GROUP",
            "address_2": "224 W. D.L. INGRAM AVENUE, BLDG. 1408",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27TH SPECIAL OPERATIONS MEDICAL GROUP",
            "address_2": "224 W. D.L. INGRAM AVENUE, BLDG. 1408",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88103",
            "telephone_number": "575-784-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "HOLLY",
        "middle_name": "J",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TX",
            "license": "1108222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "BOLT",
            "middle_name": "JO",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicholas E Bem, OD
• Ashton Nicole Bierbrauer-Martin, APRN, FNP-C
• Tara Rene Blackwelder, NP-C
• Ericka Jean Bond, LCSW
• Bryan W Bovitz, PHD
• Kayla Irwin Brooks
• Jade Brown
• Taylor Buessing, DPT
• Jacquin Burns, LCSW
• Genevieve R Canete

• All providers in Cannon Afb, NM
• Licensed Practical Nurse in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.