Provider Demographics
NPI:1619217627
Name:LEATH, KARLA WRIGHT (CRNP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:WRIGHT
Last Name:LEATH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1248 HUFFMAN MILL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-584-5200
Mailing Address - Fax:336-538-0099
Practice Address - Street 1:1248 HUFFMAN MILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-584-5200
Practice Address - Fax:336-538-0099
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCR162531363LF0000X
MDR162531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1619217627Medicare UPIN
NC1619217627Medicare UPIN