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OLE BROOK KIDS, P.C.
NPI 1649051046
Nurse Practitioner - Pediatrics in Brookhaven, MS

Active since October 11, 2023CLIA 25D2293540 · Waiver
508 BROOKWAY BLVD, BROOKHAVEN, MS 39601(601) 835-1062 Get Directions Write a Review

NPPES record last updated: January 25, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 25, 2026, Oct 11, 2023 (2 updates tracked since 2023).

About Ole Brook Kids, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OLE BROOK KIDS, P.C. (NPI 1649051046), doing business as Ole Brook Kids Wellness And Urgent Care, is a healthcare organization registered as a pediatrics in Brookhaven, Mississippi and active in the NPI registry since October 2023. The organization holds a CLIA Waiver certificate valid through November 8, 2027, maintains a secondary practice location in Brookhaven, and lists Amber Nicole Martin, Owner/nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1649051046
Entity TypeOrganization
Primary Taxonomy363LP0200X
Legal Business NameOLE BROOK KIDS, P.C.
Location Address508 BROOKWAY BLVDBrookhaven, MS 39601-3267
Mailing AddressPo Box 1403Brookhaven, MS 39602-1403 · (601) 757-9689
Phone(601) 835-1062
Organization SubpartNo
Authorized OfficialAmber Nicole MartinOwner/nurse Practitioner · (601) 757-9689
Enumeration DateOctober 11, 2023
Last NPPES UpdateJanuary 25, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 25, 2026
✔ NPI 1649051046 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
508 BROOKWAY BLVD, Brookhaven, MS 39601
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Other Names 1

Doing Business AsOle Brook Kids Wellness And Urgent Care

Secondary Practice Location 1

Location 1301C Highway 51 SBrookhaven, MS 39601-3247 · Phone (601) 835-1062 · Fax (601) 835-9233

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2293540

Ole Brook Kids PC · Brookhaven, MS
Active · expires Nov 8, 2027
CLIA Number25D2293540
Laboratory TypePractitioner Other
Certificate Effective DateNovember 9, 2025
Certificate Expiration DateNovember 8, 2027
Laboratory DirectorKayla D. Thurman
Laboratory Phone(601) 835-1062
Laboratory LocationOle Brook Kids PC508 Brookway Blvd, Brookhaven, MS 39601
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. EMILY CATHERINE GANDENBERGER CPNP-PC
Nurse Practitioner (Pediatrics)
508 BROOKWAY BLVD
BROOKHAVEN, MS 39601
Lincoln County (601) 896-3898

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ole Brook Kids, P.C.'s NPI number?

The NPI number for Ole Brook Kids, P.C. is 1649051046. It was assigned to this organization in the NPPES registry on October 11, 2023. The provider is doing business as Ole Brook Kids Wellness and Urgent Care.

Where is Ole Brook Kids, P.C. located?

Ole Brook Kids, P.C. is located at 508 Brookway Blvd, Brookhaven, MS 39601. The listed phone number is (601) 835-1062.

What is Ole Brook Kids, P.C.'s specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Does Ole Brook Kids, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2293540) is associated with this NPI, valid through November 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Ole Brook Kids, P.C. accept?

Health plans from Molina Healthcare list Ole Brook Kids, P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ole Brook Kids, P.C. was last updated on January 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.