Provider Demographics
NPI:1306100672
Name:BROOKS, HEATHER L (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PINE CIR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1138
Mailing Address - Country:US
Mailing Address - Phone:504-913-5454
Mailing Address - Fax:
Practice Address - Street 1:1570 LINDBERG DR # 10-12
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8083
Practice Address - Country:US
Practice Address - Phone:985-643-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06867363LF0000X
MSR892477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily