Healthcare Provider Details

I. General information

NPI: 1538459078
Provider Name (Legal Business Name): LEAURA BROOKE GALBRAITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAURA BROOKE WHITWORTH NP

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 EARL FRYE BLVD
AMORY MS
38821-5519
US

IV. Provider business mailing address

1035 TEMPLE AVE N
FAYETTE AL
35555-1923
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-6090
  • Fax:
Mailing address:
  • Phone: 205-748-0158
  • Fax: 205-932-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR864191
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF0611195
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: