Healthcare Provider Details

I. General information

NPI: 1356336549
Provider Name (Legal Business Name): LEIGH A NELSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD ST. LUKE'S MULTI-SPECIALTY CLINIC, MEDICAL PLAZA BLDG.
KANSAS CITY MO
64111-3217
US

IV. Provider business mailing address

2411 HOLMES ST UMKC SCHOOL OF PHARMACY M3-C19 MEDICAL SCHOOL BLDG
KANSAS CITY MO
64108-2741
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-9095
  • Fax: 816-932-3143
Mailing address:
  • Phone: 816-932-9095
  • Fax: 816-932-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberMO 43599
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: