Healthcare Provider Details

I. General information

NPI: 1407312127
Provider Name (Legal Business Name): KHRISTINN KELLIE LEITCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5139
  • Fax: 601-984-5151
Mailing address:
  • Phone: 601-984-5139
  • Fax: 601-984-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number26529
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: