Healthcare Provider Details

I. General information

NPI: 1578268868
Provider Name (Legal Business Name): LEANNA BROOKE TAYLOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 HOLTON AVE E STE 303
BIG STONE GAP VA
24219-3367
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-8681
  • Fax: 276-523-8684
Mailing address:
  • Phone: 423-952-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102210181
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: