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General NPI Number Information
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NPI Number | 1730612409
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Entity Type | Individual
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Provider Name | LEAH BETH CHICUNQUE
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Gender | Female
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Dates
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Enumeration Date | 04/09/2017
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 617 23RD ST STE 212
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City | ASHLAND
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State | KY
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Zip | 41101-2883
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Country | US
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Telephone | 606-408-8485
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1595
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City | ASHLAND
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State | KY
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Zip | 41105-1595
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.137152
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 53995
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License Number State | KY
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