Healthcare Provider Details

I. General information

NPI: 1316491012
Provider Name (Legal Business Name): LAURA-JEAN SCOTT BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MARION AVE
MCCOMB MS
39648-2709
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-6891
  • Fax: 601-249-3834
Mailing address:
  • Phone: 601-249-2701
  • Fax: 601-249-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901532
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: