Provider Demographics
NPI:1275186538
Name:LEAKES, WILLIAM MCKINLEY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MCKINLEY
Last Name:LEAKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 S EASTERN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2300
Mailing Address - Country:US
Mailing Address - Phone:702-798-0553
Mailing Address - Fax:702-798-0553
Practice Address - Street 1:5160 S EASTERN AVE STE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2300
Practice Address - Country:US
Practice Address - Phone:702-798-0553
Practice Address - Fax:702-798-0553
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1588103121Medicaid