Healthcare Provider Details

I. General information

NPI: 1881066124
Provider Name (Legal Business Name): LEIGHNIA TYRESE NANCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 HELMSDALE PL
LEXINGTON KY
40509-2213
US

IV. Provider business mailing address

858 EASTERN BYP
RICHMOND KY
40475-2512
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-6401
  • Fax: 859-258-6438
Mailing address:
  • Phone: 859-626-0072
  • Fax: 859-626-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1118961
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009993
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: