Provider Demographics
NPI:1922539279
Name:LEONARD, JACOB KYLE (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:KYLE
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3407
Mailing Address - Country:US
Mailing Address - Phone:337-828-5099
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL DR STE C
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-4231
Practice Address - Country:US
Practice Address - Phone:337-907-6762
Practice Address - Fax:337-907-6102
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330961208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery