Provider Demographics
NPI:1619290749
Name:LEONARD, PEGGY KERRES (CRNA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:KERRES
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LEEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3910
Mailing Address - Country:US
Mailing Address - Phone:865-368-7070
Mailing Address - Fax:
Practice Address - Street 1:200 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6810
Practice Address - Country:US
Practice Address - Phone:615-768-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH082939367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered