Provider Demographics
NPI:1629465133
Name:MCBROOM, LESLIE (NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 TROTWOOD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6436
Mailing Address - Country:US
Mailing Address - Phone:931-540-4140
Mailing Address - Fax:931-540-4142
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-540-4140
Practice Address - Fax:931-540-4142
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily