Provider Demographics
NPI:1487837928
Name:DANIELS, LEAH K (MSN, APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:K
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:K
Other - Last Name:TRAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN-BC
Mailing Address - Street 1:778 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9300
Mailing Address - Country:US
Mailing Address - Phone:601-914-9620
Mailing Address - Fax:601-914-9620
Practice Address - Street 1:778 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9300
Practice Address - Country:US
Practice Address - Phone:601-914-9620
Practice Address - Fax:601-914-9620
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13072363L00000X
TNAPN013072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341468Medicare PIN