Provider Demographics
NPI:1669637468
Name:PRIVETT, LEAH CHRISTEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:CHRISTEN
Last Name:PRIVETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1479
Mailing Address - Country:US
Mailing Address - Phone:870-926-0207
Mailing Address - Fax:
Practice Address - Street 1:1016 MCQUAY AVE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455
Practice Address - Country:US
Practice Address - Phone:870-895-9949
Practice Address - Fax:870-895-0208
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily