Provider Demographics
NPI:1265790075
Name:CHERY-LEONARD, ALTA CARMELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALTA
Middle Name:CARMELLE
Last Name:CHERY-LEONARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7560
Mailing Address - Country:US
Mailing Address - Phone:681-247-1250
Mailing Address - Fax:
Practice Address - Street 1:120 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7560
Practice Address - Country:US
Practice Address - Phone:681-247-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily