Provider Demographics
NPI:1629682372
Name:SMITH, BROOKE LEIGH (RN, BSN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6931
Mailing Address - Country:US
Mailing Address - Phone:225-665-4079
Mailing Address - Fax:225-665-4114
Practice Address - Street 1:12555 BROWN RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6931
Practice Address - Country:US
Practice Address - Phone:225-665-4079
Practice Address - Fax:225-665-5248
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN121965163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
14276OtherSCHOOL NURSE