Provider Demographics
NPI:1003655309
Name:LEISRING, ANDREW PAUL (PMHNP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:LEISRING
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2315
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-2315
Mailing Address - Country:US
Mailing Address - Phone:513-373-6017
Mailing Address - Fax:
Practice Address - Street 1:5500 MAGNOLIA RUN CIR APT 107
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-1677
Practice Address - Country:US
Practice Address - Phone:513-373-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189087363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health