Provider Demographics
NPI:1164295010
Name:LEATHERMAN, HALIE J (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:J
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 MAGNOLIA GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7902
Mailing Address - Country:US
Mailing Address - Phone:980-241-9628
Mailing Address - Fax:
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-448-9100
Practice Address - Fax:336-778-7995
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC316466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily