MEDICARE: MRS. D'ANN DICKSON LEIGH APRN

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	363LF0000X	Family Nurse Practitioner	1070018	TX

General Provider Information

NPI Number	:	1740936954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. D'ANN DICKSON LEIGH APRN

Provider Business Mailing Address
First Line	:	4421 STATE HIGHWAY 6 S STE 100
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-6176
Country	:	US
Telephone Number	:	799-690-4828
Fax Number	:	979-690-4829

Provider Business Practice Location Address
First Line	:	1612 W VILLA MARIA RD STE 130
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77807-2310
Country	:	US
Telephone Number	:	979-690-4836
Fax Number	:	979-690-4837

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

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	03/19/2025

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