Provider Demographics
NPI:1861225666
Name:BROOKS, MICHELLE LEAVETHA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEAVETHA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2713
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:256-827-5084
Practice Address - Street 1:14400 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2713
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:256-827-5084
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025027141363LF0000X
AK140862163WC0400X
AK231027363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care