Healthcare Provider Details

I. General information

NPI: 1831934272
Provider Name (Legal Business Name): LEAH MARIE MINARD APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH KIMBLE APRN-CNP

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 STATE ROUTE 44
ROOTSTOWN OH
44272-9733
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-3202
  • Fax: 833-606-1565
Mailing address:
  • Phone: 330-325-3202
  • Fax: 833-606-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036631
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0036631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: