Provider Demographics
NPI:1164656955
Name:LEONARD, KATHERINE E (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:LEONARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SENECA ST
Mailing Address - Street 2:STE 2
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2653
Mailing Address - Country:US
Mailing Address - Phone:315-361-1041
Mailing Address - Fax:315-361-1044
Practice Address - Street 1:603 SENECA ST
Practice Address - Street 2:STE 2
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2653
Practice Address - Country:US
Practice Address - Phone:315-361-1041
Practice Address - Fax:315-361-1044
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03465203Medicaid
NYJ400077793Medicare PIN