Provider Demographics
NPI:1578245247
Name:PURYEAR, LEISHA KALB (RN)
Entity Type:Individual
Prefix:MRS
First Name:LEISHA
Middle Name:KALB
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12018 W BROAD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7796
Mailing Address - Country:US
Mailing Address - Phone:180-428-7202
Mailing Address - Fax:
Practice Address - Street 1:12018 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7796
Practice Address - Country:US
Practice Address - Phone:804-287-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001269696163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery