Provider Demographics
NPI:1407487069
Name:RYBOLT, LEAH LAMB
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:LAMB
Last Name:RYBOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6100
Mailing Address - Country:US
Mailing Address - Phone:662-645-5324
Mailing Address - Fax:662-627-5106
Practice Address - Street 1:2000 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6100
Practice Address - Country:US
Practice Address - Phone:662-627-7361
Practice Address - Fax:662-627-5106
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903740363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily