Provider Demographics
NPI:1821033382
Name:LEATH, SARAH JANE (FPMHNP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:LEATH
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
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Mailing Address - Street 1:208 PINELEAF CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4451
Mailing Address - Country:US
Mailing Address - Phone:601-919-1180
Mailing Address - Fax:601-919-1180
Practice Address - Street 1:98 BURNHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2703
Practice Address - Country:US
Practice Address - Phone:601-664-0204
Practice Address - Fax:601-664-0904
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR855174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSQ42694Medicare UPIN