Healthcare Provider Details

I. General information

NPI: 1629539366
Provider Name (Legal Business Name): KATHERINE CORLEY LEACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE CLAIRE CORLEY

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 FRY RD STE 600
CYPRESS TX
77433-3695
US

IV. Provider business mailing address

13203 FRY RD STE 600
CYPRESS TX
77433-3695
US

V. Phone/Fax

Practice location:
  • Phone: 281-304-5559
  • Fax:
Mailing address:
  • Phone: 281-304-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT7278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: