Provider Demographics
NPI:1053489799
Name:LEAVY, KATHLEEN RAE (RN, AP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RAE
Last Name:LEAVY
Suffix:
Gender:F
Credentials:RN, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 SE 30TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-9364
Mailing Address - Country:US
Mailing Address - Phone:352-375-0987
Mailing Address - Fax:
Practice Address - Street 1:804 NW 16TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4012
Practice Address - Country:US
Practice Address - Phone:352-379-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP0000407171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist