MEDICARE: TATIANA I LEAKEY

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	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86111227	OTHER		CDR

General Provider Information

NPI Number	:	1386286540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA I LEAKEY

Provider Business Mailing Address
First Line	:	6306 WINDCREST DR APT 1718
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3027
Country	:	US
Telephone Number	:	501-920-7851
Fax Number	:

Provider Business Practice Location Address
First Line	:	6306 WINDCREST DR APT 1718
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3027
Country	:	US
Telephone Number	:	501-920-7851
Fax Number	:

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

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	12/25/2025

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Directions to “ TATIANA I LEAKEY ” Practice Location

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