Provider Demographics
NPI:1134896244
Name:LEONARD, KIRSTEN HOPE
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:HOPE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-0346
Mailing Address - Country:US
Mailing Address - Phone:240-625-0499
Mailing Address - Fax:
Practice Address - Street 1:74 CHIVE LANE
Practice Address - Street 2:
Practice Address - City:FALLING WATERS
Practice Address - State:WV
Practice Address - Zip Code:25419
Practice Address - Country:US
Practice Address - Phone:240-625-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker