Provider Demographics
NPI:1700525896
Name:LEAKEY, CECELIA
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:LEAKEY
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 1:6518 SE BERRYTON RD
Mailing Address - Street 2:
Mailing Address - City:BERRYTON
Mailing Address - State:KS
Mailing Address - Zip Code:66409-9569
Mailing Address - Country:US
Mailing Address - Phone:785-640-9388
Mailing Address - Fax:
Practice Address - Street 1:9100 PARK ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3353
Practice Address - Country:US
Practice Address - Phone:913-888-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS134036163WG0600X
KS81233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontology