Provider Demographics
NPI:1023903911
Name:CUNNINGHAM, LESHAIRIA
Entity type:Individual
Prefix:
First Name:LESHAIRIA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MARKET ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1824
Mailing Address - Country:US
Mailing Address - Phone:636-204-0027
Mailing Address - Fax:636-202-9327
Practice Address - Street 1:117 S LEXINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2444
Practice Address - Country:US
Practice Address - Phone:636-204-0027
Practice Address - Fax:636-202-9327
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023011248164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty