Provider Demographics
NPI:1619477981
Name:PEACOCK SMITH, LEANDRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:PEACOCK SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 S FM 51
Mailing Address - Street 2:SUITE 400, BOX #130
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234
Mailing Address - Country:US
Mailing Address - Phone:940-626-1849
Mailing Address - Fax:940-626-1849
Practice Address - Street 1:902 PRESKITT RD STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-4121
Practice Address - Country:US
Practice Address - Phone:940-626-1848
Practice Address - Fax:940-626-1849
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS
TXPENDINGMedicaid