=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447705470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH PENNY CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2016
-----------------------------------------------------
Last Update Date | 12/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 S MONTGOMERY AVE
-----------------------------------------------------
City | SHEFFIELD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35660-6334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-386-4680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 S JACKSON HWY STE 300
-----------------------------------------------------
City | SHEFFIELD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35660-5773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-386-4680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1106413
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------