Provider Demographics
NPI:1194507715
Name:LEACH, KORI HESTER (LVN)
Entity type:Individual
Prefix:MRS
First Name:KORI
Middle Name:HESTER
Last Name:LEACH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6989 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-4168
Mailing Address - Country:US
Mailing Address - Phone:325-998-5977
Mailing Address - Fax:
Practice Address - Street 1:6989 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-4168
Practice Address - Country:US
Practice Address - Phone:325-998-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care