Healthcare Provider Details

I. General information

NPI: 1609861442
Provider Name (Legal Business Name): LEIGH SUZANNE JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH SAYLOR

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W STONE DR STE 200
KINGSPORT TN
37660-6028
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-723-2030
  • Fax:
Mailing address:
  • Phone: 423-952-2111
  • Fax: 423-282-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6600
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9404067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: