Healthcare Provider Details

I. General information

NPI: 1144709429
Provider Name (Legal Business Name): LEAH PRESCOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RITCHIE HWY
PASADENA MD
21122-3905
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 443-573-0564
  • Fax: 443-573-0565
Mailing address:
  • Phone: 804-822-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR219167
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: