MEDICARE: MRS. LEANDREA DIANE SMITH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	77192	KS

General Provider Information

NPI Number	:	1164873451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEANDREA DIANE SMITH NP

Provider Business Mailing Address
First Line	:	1624 S 102ND ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66111
Country	:	US
Telephone Number	:	913-421-9228
Fax Number	:	913-246-4437

Provider Business Practice Location Address
First Line	:	1624 S 102ND ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66111
Country	:	US
Telephone Number	:	913-421-9228
Fax Number	:	913-246-4437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	04/04/2026

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