Provider Demographics
NPI:1275822520
Name:LEONARD, KELLEY MANION (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MANION
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 GOLDEN FOOTHILL PARKWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-941-7362
Mailing Address - Fax:
Practice Address - Street 1:4989 GOLDEN FOOTHILL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9639
Practice Address - Country:US
Practice Address - Phone:916-941-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087100163W00000X, 363LF0000X
FL9212041363LF0000X
CA95002404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse