Provider Demographics
NPI:1164873451
Name:SMITH, LEANDREA DIANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LEANDREA
Middle Name:DIANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 STRONG AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-2116
Mailing Address - Country:US
Mailing Address - Phone:913-262-0550
Mailing Address - Fax:913-831-3048
Practice Address - Street 1:3200 STRONG AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-2116
Practice Address - Country:US
Practice Address - Phone:913-262-0550
Practice Address - Fax:913-831-3048
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily