Provider Demographics
NPI:1871661595
Name:FARRELL, LESLIE BROOKE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:BROOKE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 PRICE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4095
Mailing Address - Country:US
Mailing Address - Phone:347-351-0585
Mailing Address - Fax:
Practice Address - Street 1:FORT HOOD ARMY PUBLIC HEALTH NURSING
Practice Address - Street 2:BLDG 4222, 77TH ST. & TANK DESTOYER BLVD
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-6789
Practice Address - Fax:254-288-9383
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543462-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health