Healthcare Provider Details

I. General information

NPI: 1598573131
Provider Name (Legal Business Name): LEAH KAYTLYN GIRDNER RN, BSN,CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

415 RAIDER BLVD
WOLFFORTH TX
79382-5309
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-8200
  • Fax:
Mailing address:
  • Phone: 806-777-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1036513
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: