Provider Demographics
NPI:1578238283
Name:SCOTT, BROOKE LEEANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEEANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LEEANN
Other - Last Name:COLCLASURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 303
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8955
Practice Address - Country:US
Practice Address - Phone:254-202-0480
Practice Address - Fax:254-202-0488
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050527363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care