Provider Demographics
NPI:1669924296
Name:LEATH, ROBERT PAUL JR (APRN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:LEATH
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 PONDER CT
Mailing Address - Street 2:STE 104
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9050
Mailing Address - Country:US
Mailing Address - Phone:859-236-4852
Mailing Address - Fax:
Practice Address - Street 1:UK DIVISION OF HOSPITAL MEDICINE
Practice Address - Street 2:800 ROSE STREET, MN604
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-323-6047
Practice Address - Fax:859-257-3873
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3010834363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care