Provider Demographics
NPI:1578907309
Name:LEEDY, KRISTEN M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:LEEDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 OLEANDER CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9099
Mailing Address - Country:US
Mailing Address - Phone:937-672-0771
Mailing Address - Fax:
Practice Address - Street 1:770 OLEANDER CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9099
Practice Address - Country:US
Practice Address - Phone:937-672-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152710-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse