Healthcare Provider Details

I. General information

NPI: 1134599764
Provider Name (Legal Business Name): BRIONNA VIRGINIA LEAHY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE KENTUCKY CLINIC L524
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

740 N LIMESTONE KENTUCKY CLINIC L524
LEXINGTON KY
40508-1683
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2277
  • Fax:
Mailing address:
  • Phone: 859-323-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3009762
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number3009762
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: