Provider Demographics
NPI:1861433187
Name:LEUENBERGER, MELISSA N (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:N
Last Name:LEUENBERGER
Suffix:
Gender:F
Credentials:APRN
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 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:391 W TOM T HALL BLVD
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-7688
Practice Address - Country:US
Practice Address - Phone:606-286-8039
Practice Address - Fax:606-286-6108
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000853026OtherANTHEM
KY78007127Medicaid
000000215836OtherBLUE CROSS
1193300OtherCHA
OH3027567Medicaid
500024067OtherRAILROAD MEDICARE
KYP01320945OtherRR MEDICARE
KY78007127Medicaid
KYK053001Medicare PIN
KY000000853026OtherANTHEM
KYP53174Medicare UPIN