Provider Demographics
NPI:1578869764
Name:LEONARD, BRITTANY DANAE (PA)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:DANAE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:BRITTANY
Other - Middle Name:DANAE
Other - Last Name:BOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3501 OLD GREENWOOD RD STE 10
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5964
Mailing Address - Country:US
Mailing Address - Phone:479-226-5212
Mailing Address - Fax:479-434-3535
Practice Address - Street 1:3501 OLD GREENWOOD RD STE 10
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5964
Practice Address - Country:US
Practice Address - Phone:479-226-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA425OtherPA