=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922393842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEANNE M KLINE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2011
-----------------------------------------------------
Last Update Date | 03/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1409 ASHEVILLE HWY
-----------------------------------------------------
City | BREVARD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28712-9524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-435-8400
-----------------------------------------------------
Fax | 828-435-8401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SAINT CLAIR AVE JTDM FAMILY PRACTICE LLC
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45885-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-394-3387
-----------------------------------------------------
Fax | 419-394-9580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35.123708
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2020-00325
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------