Healthcare Provider Details

I. General information

NPI: 1518882349
Provider Name (Legal Business Name): LEAH GERRED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 PHOENIX AVE
FORT SMITH AR
72903-6430
US

IV. Provider business mailing address

402 RIDGE DR
SALLISAW OK
74955-3081
US

V. Phone/Fax

Practice location:
  • Phone: 479-646-3711
  • Fax: 479-648-8266
Mailing address:
  • Phone: 479-646-3711
  • Fax: 479-648-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number225138
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: