Provider Demographics
NPI:1538658786
Name:KELLEY, BROOKE LEIGH (MSN WHNP-BC IBCLC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEIGH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSN WHNP-BC IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 GATES BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-3810
Mailing Address - Country:US
Mailing Address - Phone:409-989-5858
Mailing Address - Fax:
Practice Address - Street 1:3535 GATES BLVD STE 116
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-3810
Practice Address - Country:US
Practice Address - Phone:409-989-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135798363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health