Healthcare Provider Details

I. General information

NPI: 1801207824
Provider Name (Legal Business Name): ALANA LEAVELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 METKER TRL
STANFORD KY
40484-1020
US

IV. Provider business mailing address

110 METKER TRL
STANFORD KY
40484-1020
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-4160
  • Fax:
Mailing address:
  • Phone: 606-365-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008765
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1121016
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: