Provider Demographics
NPI:1851447585
Name:WERNER-LEAP, KATHLEEN (CNS, NPP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:WERNER-LEAP
Suffix:
Gender:F
Credentials:CNS, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N ARTHUR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3006
Mailing Address - Country:US
Mailing Address - Phone:208-233-2998
Mailing Address - Fax:208-232-0881
Practice Address - Street 1:427 N ARTHUR AVE STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3006
Practice Address - Country:US
Practice Address - Phone:208-233-2998
Practice Address - Fax:208-232-0881
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS-15A, N-28258363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010149937OtherREGENCE BLUE SHIELD
IDNPSB4OtherBLUE CROSS
ID1305039Medicare ID - Type Unspecified
ID000010149937OtherREGENCE BLUE SHIELD