Healthcare Provider Details

I. General information

NPI: 1932527371
Provider Name (Legal Business Name): LEAH C HARRIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 AL HIGHWAY 157 STE 101
CULLMAN AL
35058-1273
US

IV. Provider business mailing address

503 CLARK ST NE
CULLMAN AL
35055-1921
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-4131
  • Fax: 256-739-6027
Mailing address:
  • Phone: 256-739-0801
  • Fax: 256-739-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-128261
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: