Provider Demographics
NPI:1275771016
Name:HERSTON, LEAH DOSS (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:DOSS
Last Name:HERSTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7377 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634
Mailing Address - Country:US
Mailing Address - Phone:256-757-0194
Mailing Address - Fax:256-757-0197
Practice Address - Street 1:7377 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634
Practice Address - Country:US
Practice Address - Phone:256-757-0194
Practice Address - Fax:256-757-0197
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13451363LF0000X
AL1-138353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1275771016OtherMEDICARE NPI