Healthcare Provider Details

I. General information

NPI: 1497172456
Provider Name (Legal Business Name): CASIE LEIGHTNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 9TH ST SE
SIOUX CENTER IA
51250-2501
US

IV. Provider business mailing address

1101 9TH ST SE
SIOUX CENTER IA
51250-2501
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-2609
  • Fax:
Mailing address:
  • Phone: 712-722-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1497172456
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11017517A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-49356
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: