Healthcare Provider Details

I. General information

NPI: 1174201396
Provider Name (Legal Business Name): JOY CHARISSE LEACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 HILL COUNTRY DR
KERRVILLE TX
78028-6085
US

IV. Provider business mailing address

240 PIN OAK WAY
KERRVILLE TX
78028-4034
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-7415
  • Fax:
Mailing address:
  • Phone: 361-537-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number525951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: