Healthcare Provider Details

I. General information

NPI: 1164227666
Provider Name (Legal Business Name): ANNETTE LEON PHD, MS, FACMG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8724 HUMIE OLIVE RD
APEX NC
27502-9672
US

IV. Provider business mailing address

8724 HUMIE OLIVE RD
APEX NC
27502-9672
US

V. Phone/Fax

Practice location:
  • Phone: 417-259-6099
  • Fax:
Mailing address:
  • Phone: 417-259-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number2015141
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number2011124
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: