Provider Demographics
NPI:1154843506
Name:LEONARD, FERNE KAY
Entity Type:Individual
Prefix:
First Name:FERNE
Middle Name:KAY
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FERNE
Other - Middle Name:KAY
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:308 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4406
Practice Address - Country:US
Practice Address - Phone:580-326-7862
Practice Address - Fax:580-326-0062
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732840AMedicaid