Provider Demographics
NPI:1720199276
Name:LEONARD, JENNIFER LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 OLSON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2981
Mailing Address - Country:US
Mailing Address - Phone:402-933-6300
Mailing Address - Fax:402-916-5078
Practice Address - Street 1:8027 S 83RD AVE
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2490
Practice Address - Country:US
Practice Address - Phone:402-679-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115179363L00000X
SD454363L00000X
IAA120565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6829762Medicaid
SD6829763Medicaid
SD6829764Medicaid
SD6829760Medicaid
SD6829763Medicaid
SDS102042Medicare PIN