Provider Demographics
NPI:1417661455
Name:WESTBROOK, ALEX (RN)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COMET DR STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4333
Mailing Address - Country:US
Mailing Address - Phone:769-257-5169
Mailing Address - Fax:
Practice Address - Street 1:360 COMET DR STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4333
Practice Address - Country:US
Practice Address - Phone:769-257-5169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide