Healthcare Provider Details

I. General information

NPI: 1346720968
Provider Name (Legal Business Name): LEIGH ANN GEBHARDT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MONARCH ST STE 100
LEXINGTON KY
40513-1820
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 859-296-3141
  • Fax: 859-296-3144
Mailing address:
  • Phone: 502-272-5063
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012236
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3012236
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: