Basic Information
| Provider Information | |||||||||
| NPI: | 1881066124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NANCE | ||||||||
| FirstName: | LEIGHNIA | ||||||||
| MiddleName: | TYRESE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 858 EASTERN BYP | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404752512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596260072 | ||||||||
| FaxNumber: | 8596269684 | ||||||||
| Practice Location | |||||||||
| Address1: | 3099 HELMSDALE PL | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405092213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592586401 | ||||||||
| FaxNumber: | 8592586438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2015 | ||||||||
| LastUpdateDate: | 12/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1118961 | KY | N | Nursing Service Providers | Registered Nurse | 363L00000X | 3009993 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1118961 | 01 | KY | RN NUMBER | OTHER |