Provider Demographics
NPI:1710316476
Name:STANFORD, LEEANN BOYLES (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:BOYLES
Last Name:STANFORD
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 1:2714 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1743
Mailing Address - Country:US
Mailing Address - Phone:205-494-9777
Mailing Address - Fax:
Practice Address - Street 1:156 TITAN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1197
Practice Address - Country:US
Practice Address - Phone:256-740-0690
Practice Address - Fax:256-740-0694
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily