Healthcare Provider Details

I. General information

NPI: 1831604065
Provider Name (Legal Business Name): KATIE LEONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 06/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 TENNEY MOUNTAIN HWY
PLYMOUTH NH
03264
US

IV. Provider business mailing address

PO BOX 659
RUMNEY NH
03266-0659
US

V. Phone/Fax

Practice location:
  • Phone: 603-481-8787
  • Fax:
Mailing address:
  • Phone: 760-791-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP10947
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number079986-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN211245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: