Basic Information
| Provider Information | |||||||||
| NPI: | 1174531925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEACH | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEWIS | ||||||||
| OtherFirstName: | MARION | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ARNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 784 HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | FRENCHBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403228123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067689190 | ||||||||
| FaxNumber: | 6067689180 | ||||||||
| Practice Location | |||||||||
| Address1: | 784 HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | FRENCHBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403228123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067689190 | ||||||||
| FaxNumber: | 6067689180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4215P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 183949 | 01 | KY | RURAL HEALTH MEDICARE | OTHER | 65945198 | 05 | KY | MEDICAID | 78010998 | 05 | KY | MEDICAID | 35002021 | 01 | KY | RURAL HEALTH MEDICAID | OTHER | 35002021 | 05 | KY | MEDICAID |