Provider Demographics
NPI:1225391360
Name:BRABHAM, MICHAELYN H (NP)
Entity Type:Individual
Prefix:
First Name:MICHAELYN
Middle Name:H
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:ATTN: CAMILLE/ ADMINISTRATION
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4326
Mailing Address - Country:US
Mailing Address - Phone:225-769-4044
Mailing Address - Fax:
Practice Address - Street 1:7373 PERKINS RD
Practice Address - Street 2:ATTN: CAMILLE/ ADMINISTRATION
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4326
Practice Address - Country:US
Practice Address - Phone:225-769-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP06909OtherSTATE LICENSE