Provider Demographics
NPI:1508320920
Name:LEINER, KATHLEEN HARRELL (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HARRELL
Last Name:LEINER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:LEANNE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 W BROAD ST # 842022
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23284-9089
Mailing Address - Country:US
Mailing Address - Phone:804-828-8828
Mailing Address - Fax:804-828-1093
Practice Address - Street 1:1300 W BROAD ST # 842022
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-9089
Practice Address - Country:US
Practice Address - Phone:804-828-8828
Practice Address - Fax:804-828-1093
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty