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General NPI Number Information
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NPI Number | 1942977301
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Entity Type | Individual
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Provider Name | LEAH CARLSON
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 01/09/2022
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Provider Practice Location Address
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Address Line | 2201 HORIZAN RD STE 4
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-2926
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Country | US
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Telephone | 870-732-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 401 COUNTRY CLUB RD
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-3883
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Country | US
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Telephone | 501-766-6774
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 217600
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 30222
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 217600
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R093788
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License Number State | AR
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