MEDICARE: DR. LEIGH A NELSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	MO 43599	MO

General Provider Information

NPI Number	:	1356336549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEIGH A NELSON PHARMD

Provider Business Mailing Address
First Line	:	2411 HOLMES ST
Second Line	:	UMKC SCHOOL OF PHARMACY M3-C19 MEDICAL SCHOOL BLDG
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2741
Country	:	US
Telephone Number	:	816-932-9095
Fax Number	:	816-932-3143

Provider Business Practice Location Address
First Line	:	4330 WORNALL RD
Second Line	:	ST. LUKE'S MULTI-SPECIALTY CLINIC, MEDICAL PLAZA BLDG.
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3217
Country	:	US
Telephone Number	:	816-932-9095
Fax Number	:	816-932-3143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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