Provider Demographics
NPI:1548912033
Name:WILLIAMS, BROOKE JOHNINE (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:JOHNINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2989
Mailing Address - Country:US
Mailing Address - Phone:318-680-7856
Mailing Address - Fax:
Practice Address - Street 1:111 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2989
Practice Address - Country:US
Practice Address - Phone:318-680-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily