Provider Demographics
NPI:1548674419
Name:LEACH, LINDA SUE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:LEACH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:KOCHANEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:975 E. THIRD STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5630
Mailing Address - Fax:423-778-3146
Practice Address - Street 1:632 MORRISON SPRINGS ROAD
Practice Address - Street 2:SUITE #202
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-778-3390
Practice Address - Fax:423-778-3391
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000018725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily