Healthcare Provider Details

I. General information

NPI: 1740936954
Provider Name (Legal Business Name): D'ANN DICKSON LEIGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 W VILLA MARIA RD STE 130
BRYAN TX
77807-2310
US

IV. Provider business mailing address

4421 STATE HIGHWAY 6 S STE 100
COLLEGE STATION TX
77845-6176
US

V. Phone/Fax

Practice location:
  • Phone: 979-690-4836
  • Fax: 979-690-4837
Mailing address:
  • Phone: 799-690-4828
  • Fax: 979-690-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1070018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: