Provider Demographics
NPI:1518217967
Name:LEONARD, KYM L (DNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KYM
Middle Name:L
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 OLD ROSWELL RD STE 211
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8686
Mailing Address - Country:US
Mailing Address - Phone:404-856-0505
Mailing Address - Fax:404-602-0081
Practice Address - Street 1:760 OLD ROSWELL RD STE 211
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-8686
Practice Address - Country:US
Practice Address - Phone:404-856-0505
Practice Address - Fax:404-602-0081
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135298363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health