Basic Information
Provider Information
NPI: 1003299116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROOKS
FirstName: LEIGH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3997 BECKLEY RD
Address2:  
City: PRINCETON
State: WV
PostalCode: 247407660
CountryCode: US
TelephoneNumber: 3044315499
FaxNumber: 3044313400
Practice Location
Address1: 3997 BECKLEY RD
Address2:  
City: PRINCETON
State: WV
PostalCode: 247407660
CountryCode: US
TelephoneNumber: 3044315499
FaxNumber: 3044313400
Other Information
ProviderEnumerationDate: 07/07/2015
LastUpdateDate: 06/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPRN81187-NP-CWVY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000XAPRN81187-NP-CWVN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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