Healthcare Provider Details

I. General information

NPI: 1295731016
Provider Name (Legal Business Name): ANNMARIE MCRENA LEDLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 WESLEY ST
GREENVILLE TX
75401-5644
US

IV. Provider business mailing address

4311 WESLEY ST
GREENVILLE TX
75401-5639
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-5986
  • Fax: 903-454-4621
Mailing address:
  • Phone: 903-455-5986
  • Fax: 903-454-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK6640
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS013698
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberK6640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: