Provider Demographics
NPI:1851632350
Name:BROADY, TREKESHA D (NP)
Entity Type:Individual
Prefix:MS
First Name:TREKESHA
Middle Name:D
Last Name:BROADY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TREKESHA
Other - Middle Name:DESHON
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 15TH STREET
Mailing Address - Street 2:OR-6000
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-3813
Mailing Address - Fax:
Practice Address - Street 1:EMILE @ 42ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198
Practice Address - Country:US
Practice Address - Phone:402-559-0692
Practice Address - Fax:402-559-6779
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168369363LA2100X
NE112359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner