Provider Demographics
NPI:1326699612
Name:WATKINS, LEAH ELIZABETH (NP)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:ELIZABETH
Last Name:WATKINS
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 1:7393 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:LA
Mailing Address - Zip Code:70581-3503
Mailing Address - Country:US
Mailing Address - Phone:337-370-1046
Mailing Address - Fax:
Practice Address - Street 1:1890 W GAUTHIER RD STE 135
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-480-5510
Practice Address - Fax:337-480-5511
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2517091Medicaid