Provider Demographics
NPI:1457845745
Name:LEONDIKE, JOHN MICHEAL (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHEAL
Last Name:LEONDIKE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 WHITE FEATHER TRL
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-3281
Mailing Address - Country:US
Mailing Address - Phone:032-472-0135
Mailing Address - Fax:
Practice Address - Street 1:12804 GULF FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4850
Practice Address - Country:US
Practice Address - Phone:832-472-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137791363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care