Provider Demographics
NPI:1528541489
Name:LEATH, JAMES ANDREW (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:LEATH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 MARI BETH LN
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-1117
Mailing Address - Country:US
Mailing Address - Phone:903-918-2833
Mailing Address - Fax:903-385-7473
Practice Address - Street 1:912 WALNUT HILL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5052
Practice Address - Country:US
Practice Address - Phone:903-291-6300
Practice Address - Fax:903-291-6305
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX736743163W00000X
TXAP138718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse