Provider Demographics
NPI:1093921504
Name:EARLE, LEIGH POWELL (MS APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:POWELL
Last Name:EARLE
Suffix:
Gender:F
Credentials:MS APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 WESTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3320
Mailing Address - Country:US
Mailing Address - Phone:307-237-5851
Mailing Address - Fax:
Practice Address - Street 1:475 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1759
Practice Address - Country:US
Practice Address - Phone:307-235-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13606.0173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115200900Medicaid