Provider Demographics
NPI:1528476959
Name:BORSKEY, BROOKE BRIDEVAUX (PA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BRIDEVAUX
Last Name:BORSKEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ASHLEY
Other - Last Name:BRIDEVAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0001
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1023 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5002
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-647-5342
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00658361Medicaid
LA00658361Medicaid