Provider Demographics
NPI:1548092588
Name:COLLIER, LEANNA MARIE
Entity type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:MARIE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:M
Other - Last Name:ISBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 SPANISH OAK CIR
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-4156
Mailing Address - Country:US
Mailing Address - Phone:931-205-2323
Mailing Address - Fax:
Practice Address - Street 1:1235 E CHEROKEE ST STE 2C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2203
Practice Address - Country:US
Practice Address - Phone:417-820-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024040833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant