Provider Demographics
NPI:1437632981
Name:FROMM, LEIGH ANN (PMHNP, FNP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:FROMM
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:IL
Mailing Address - Zip Code:62979-2506
Mailing Address - Country:US
Mailing Address - Phone:620-238-1006
Mailing Address - Fax:
Practice Address - Street 1:813 E 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-2012
Practice Address - Country:US
Practice Address - Phone:812-450-1325
Practice Address - Fax:812-838-9214
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009272A363L00000X
IL209018147363LF0000X, 363LP0808X
IL041418907163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse