Healthcare Provider Details

I. General information

NPI: 1760047971
Provider Name (Legal Business Name): LEANNA VICTORIA RITCHIE M.D., M.B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date: 12/16/2019
Reactivation Date: 12/27/2019

III. Provider practice location address

427 N WILLOW AVE STE C
COOKEVILLE TN
38501-2354
US

IV. Provider business mailing address

427 N WILLOW AVE STE C
COOKEVILLE TN
38501-2354
US

V. Phone/Fax

Practice location:
  • Phone: 931-559-5959
  • Fax:
Mailing address:
  • Phone: 931-559-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number72515
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME155011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: