Provider Demographics
NPI:1437108172
Name:LEA, BRANDI B (NP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:B
Last Name:LEA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35415 OLD LA HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-0560
Mailing Address - Country:US
Mailing Address - Phone:225-936-9662
Mailing Address - Fax:225-706-1008
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 2004
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-769-2500
Practice Address - Fax:225-706-1008
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN096450 AP04420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477346Medicaid
LAQ62454Medicare UPIN
LA1477346Medicaid