Provider Demographics
NPI:1235598434
Name:MARTIN, LEIGHANNA GRACE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEIGHANNA
Middle Name:GRACE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604B ROCHESTER CT NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-7997
Mailing Address - Country:US
Mailing Address - Phone:423-716-1734
Mailing Address - Fax:
Practice Address - Street 1:2624 ORTHO DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3484
Practice Address - Country:US
Practice Address - Phone:252-991-5261
Practice Address - Fax:252-991-5262
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily