Provider Demographics
NPI:1801173422
Name:KINGERY, LEAH (RPH)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:KINGERY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 ETHAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-1544
Mailing Address - Country:US
Mailing Address - Phone:615-681-6795
Mailing Address - Fax:
Practice Address - Street 1:2200 CHILDRENS WAY RM 2106
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4527
Practice Address - Country:US
Practice Address - Phone:615-936-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12251183500000X
ARPD10195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist