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General NPI Number Information
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NPI Number | 1902432412
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Entity Type | Individual
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Provider Name | LEASHA RAELYNN BROOKS FNP
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Gender | Female
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 2200 SW GAGE BLVD
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City | TOPEKA
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State | KS
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Zip | 66622-0001
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Country | US
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Telephone | 785-350-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 INDIANA ST
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City | BORGER
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State | TX
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Zip | 79007-6117
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Country | US
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Telephone | 806-341-8880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP141176
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License Number State | TX
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