Basic Information
| Provider Information | |||||||||
| NPI: | 1598830200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCNEIL | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | SIMS | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 BURTON HILLS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155651733 | ||||||||
| FaxNumber: | 6152960151 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 SW GOODYEAR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735059755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805106361 | ||||||||
| FaxNumber: | 5805315779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1133 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.