Provider Demographics
NPI:1154967800
Name:LEOPARD, KATHERINE LYNSEY (MED)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNSEY
Last Name:LEOPARD
Suffix:
Gender:F
Credentials:MED
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 1162
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-5162
Mailing Address - Country:US
Mailing Address - Phone:256-239-5662
Mailing Address - Fax:
Practice Address - Street 1:1215 JACKSON WAY SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-4306
Practice Address - Country:US
Practice Address - Phone:256-239-5662
Practice Address - Fax:256-217-4162
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor