Provider Demographics
NPI:1538459078
Name:GALBRAITH, LEAURA BROOKE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LEAURA
Middle Name:BROOKE
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LEAURA
Other - Middle Name:BROOKE
Other - Last Name:WHITWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1035 TEMPLE AVE N
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1923
Mailing Address - Country:US
Mailing Address - Phone:205-748-0158
Mailing Address - Fax:205-932-4159
Practice Address - Street 1:1107 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5519
Practice Address - Country:US
Practice Address - Phone:662-256-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF0611195363L00000X
MSR864191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner