Provider Demographics
NPI:1851623730
Name:LEUENBERGER, TIMOTHY RICHARD (ARNP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:LEUENBERGER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 FLEMINGSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1810
Mailing Address - Country:US
Mailing Address - Phone:606-784-1115
Mailing Address - Fax:
Practice Address - Street 1:101 JB SHANNON DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9812
Practice Address - Country:US
Practice Address - Phone:606-209-0020
Practice Address - Fax:606-209-0022
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3707P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily