Provider Demographics
NPI:1538759220
Name:LEONARD, DRAKE VINCENT (PA)
Entity type:Individual
Prefix:
First Name:DRAKE
Middle Name:VINCENT
Last Name:LEONARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-921-6975
Mailing Address - Fax:423-921-6920
Practice Address - Street 1:580 VAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-7608
Practice Address - Country:US
Practice Address - Phone:423-234-1020
Practice Address - Fax:423-234-0646
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN4408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant