Provider Demographics
NPI:1639318942
Name:LEONHART, LEXINE R (ACNP)
Entity Type:Individual
Prefix:
First Name:LEXINE
Middle Name:R
Last Name:LEONHART
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LEXINE
Other - Middle Name:R
Other - Last Name:KOEHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 S GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3206
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1235 E CHEROKEE ST
Practice Address - Street 2:2D
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2203
Practice Address - Country:US
Practice Address - Phone:417-820-2364
Practice Address - Fax:417-820-7136
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028051363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00700781OtherRAILROAD MEDICARE
MO1639318942Medicaid
431560263OtherTRICARE WEST
AR177970758Medicaid
MO1639318942Medicaid