Provider Demographics
NPI:1083955942
Name:ATABONG, LEKE (PMHNP)
Entity Type:Individual
Prefix:
First Name:LEKE
Middle Name:
Last Name:ATABONG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 OLD DULIN FARMS WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5210
Mailing Address - Country:US
Mailing Address - Phone:614-779-6227
Mailing Address - Fax:
Practice Address - Street 1:12350 OLD DULIN FARMS WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5210
Practice Address - Country:US
Practice Address - Phone:614-779-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.379759-163W00000X
NCRN9454548163W00000X
FL11001574363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty