Provider Demographics
NPI:1043798010
Name:KELLY, LEIGH ANN (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12618 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-7952
Mailing Address - Country:US
Mailing Address - Phone:936-522-7500
Mailing Address - Fax:
Practice Address - Street 1:602 W SEMANDS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1867
Practice Address - Country:US
Practice Address - Phone:936-756-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX820573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse