Healthcare Provider Details

I. General information

NPI: 1821847765
Provider Name (Legal Business Name): CHERRY LYNNE WHITE LEONARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 E BEN WHITE BLVD
AUSTIN TX
78741-7537
US

IV. Provider business mailing address

3612 BRANIGAN LN
AUSTIN TX
78759-8312
US

V. Phone/Fax

Practice location:
  • Phone: 512-673-0714
  • Fax:
Mailing address:
  • Phone: 512-673-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number230544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: