Healthcare Provider Details

I. General information

NPI: 1386101871
Provider Name (Legal Business Name): LEEANNA PETERS MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 N MOUNT AUBURN RD
CAPE GIRARDEAU MO
63701-2171
US

IV. Provider business mailing address

1417 N MOUNT AUBURN RD STE A
CAPE GIRARDEAU MO
63701-2171
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-2941
  • Fax:
Mailing address:
  • Phone: 573-803-2941
  • Fax: 573-803-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019005983
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: