Healthcare Provider Details

I. General information

NPI: 1316865637
Provider Name (Legal Business Name): LESLIE BROOKE ROSS APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 BRIGHTON PARK BLVD
SUMMERVILLE SC
29486-3100
US

IV. Provider business mailing address

424 BRIGHTON PARK BLVD
SUMMERVILLE SC
29486-3100
US

V. Phone/Fax

Practice location:
  • Phone: 843-376-6151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number32280
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: