Provider Demographics
NPI:1508843541
Name:BROOKS, JAMES WRIGHT II (CFNP/APRN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WRIGHT
Last Name:BROOKS
Suffix:II
Gender:M
Credentials:CFNP/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1801 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-424-4224
Mailing Address - Fax:318-424-4044
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-424-4224
Practice Address - Fax:318-424-4044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 84969363L00000X
LAAPRN03736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CC56Medicare ID - Type Unspecified
P21510Medicare UPIN
4B672Medicare ID - Type Unspecified