Healthcare Provider Details

I. General information

NPI: 1063656239
Provider Name (Legal Business Name): LETISHA E LEACH FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LETISHA WHEELER

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 ROESTA LN NW
BALTIMORE OH
43105-9200
US

IV. Provider business mailing address

12124 ROESTA LN NW
BALTIMORE OH
43105-9200
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-7977
  • Fax: 614-591-3744
Mailing address:
  • Phone: 614-300-7977
  • Fax: 614-591-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.10824
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.10824
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: