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NPI Code Detail

MEDICARE: MRS. LEIA DAWN O'FALLON ANP

MEDICARE: MRS. LEIA DAWN O'FALLON ANP
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
1363LX0001XObstetrics & Gynecology Nurse PractitionerA01586AR

General Provider Information

NPI Number : 1477269306
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEIA DAWN O'FALLON ANP
Provider Business Mailing Address
First Line : PO BOX 509
Second Line :
City : DERMOTT
State : AR
Zip : 71638-0509
Country : US
Telephone Number : 870-538-5414
Fax Number : 870-538-5412
Provider Business Practice Location Address
First Line : 535 JORDAN DR
Second Line :
City : MONTICELLO
State : AR
Zip : 71655-5714
Country : US
Telephone Number : 870-367-6246
Fax Number : 855-926-7383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2023
Last Update Date : 02/06/2026

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