Provider Demographics
NPI:1588217392
Name:LEYDECKER, BARRY ALLEN JR (FNP-C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALLEN
Last Name:LEYDECKER
Suffix:JR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7139 S DURANGO DR UNIT 216
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2081
Mailing Address - Country:US
Mailing Address - Phone:702-373-9169
Mailing Address - Fax:
Practice Address - Street 1:6375 W CHARLESTON BLVD BLDG L
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-259-1903
Practice Address - Fax:702-259-1907
Is Sole Proprietor?:No
Enumeration Date:2019-07-20
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV817437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily