Provider Demographics
NPI:1316412042
Name:LEONHARDT, CHRISTINE ALICIA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ALICIA
Last Name:LEONHARDT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-9636
Mailing Address - Country:US
Mailing Address - Phone:432-312-8150
Mailing Address - Fax:
Practice Address - Street 1:6516 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-9636
Practice Address - Country:US
Practice Address - Phone:432-312-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818884163W00000X
TXAP139768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse