Provider Demographics
NPI:1477710218
Name:LEATHERS, PAULA SUE (NNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUE
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 JIM SHARP BLVD
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:TX
Mailing Address - Zip Code:79745-5229
Mailing Address - Country:US
Mailing Address - Phone:432-586-2483
Mailing Address - Fax:
Practice Address - Street 1:800 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4368
Practice Address - Country:US
Practice Address - Phone:432-335-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508314363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care