Provider Demographics
NPI:1538836218
Name:LEONARD, DIANA LYNN (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 ALLISON CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-8500
Mailing Address - Country:US
Mailing Address - Phone:870-273-4177
Mailing Address - Fax:
Practice Address - Street 1:1331 CITY AVE N
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1102
Practice Address - Country:US
Practice Address - Phone:662-993-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily