Provider Demographics
NPI:1962665505
Name:SMITH, LEAH PAYNE (WHNP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:PAYNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:CATHERINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:2430 POPLAR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3246
Mailing Address - Country:US
Mailing Address - Phone:901-634-1719
Mailing Address - Fax:901-274-4709
Practice Address - Street 1:2430 POPLAR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3246
Practice Address - Country:US
Practice Address - Phone:901-634-1719
Practice Address - Fax:901-274-4709
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5816363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health