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General NPI Number Information
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NPI Number | 1306767702
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Entity Type | Individual
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Provider Name | DEMETRICA LEAVY
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Gender | Female
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 203 PECAN PARK DR
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City | RIDGELAND
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State | MS
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Zip | 39157-2817
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Country | US
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Telephone | 662-809-3755
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Fax |
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Provider Business Mailing Address
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Address Line | 203 PECAN PARK DR
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City | RIDGELAND
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State | MS
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Zip | 39157-2817
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Country | US
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Telephone | 662-809-3755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | F5W7L9G6
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License Number State | MS
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