Healthcare Provider Details

I. General information

NPI: 1518217967
Provider Name (Legal Business Name): KYM L LEONARD DNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 OLD ROSWELL RD STE 211
ROSWELL GA
30076-8686
US

IV. Provider business mailing address

760 OLD ROSWELL RD STE 211
ROSWELL GA
30076-8686
US

V. Phone/Fax

Practice location:
  • Phone: 404-856-0505
  • Fax: 404-602-0081
Mailing address:
  • Phone: 404-856-0505
  • Fax: 404-602-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN135298
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN135298
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: