Healthcare Provider Details

I. General information

NPI: 1003792011
Provider Name (Legal Business Name): LEANNA MICHELLE PHILLIPS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E STE 321
JASPER AL
35501-8951
US

IV. Provider business mailing address

9991 BANKSTON RD
DORA AL
35062-1724
US

V. Phone/Fax

Practice location:
  • Phone: 205-226-5900
  • Fax:
Mailing address:
  • Phone: 205-639-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137809
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: