Healthcare Provider Details

I. General information

NPI: 1861433187
Provider Name (Legal Business Name): MELISSA N LEUENBERGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 W TOM T HALL BLVD
OLIVE HILL KY
41164-7688
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-286-8039
  • Fax: 606-286-6108
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003705
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: