Healthcare Provider Details

I. General information

NPI: 1104485671
Provider Name (Legal Business Name): LEIGH NOELL MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 PENNSYLVANIA AVE
ORELAND PA
19075-1316
US

IV. Provider business mailing address

1254 PENNSYLVANIA AVE
ORELAND PA
19075-1316
US

V. Phone/Fax

Practice location:
  • Phone: 267-662-2799
  • Fax:
Mailing address:
  • Phone: 407-705-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP020315
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025529
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01406000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP020315
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0011110
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: