Provider Demographics
NPI:1194775791
Name:LEAMY, BRADLEY RICHAD (CRNA)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:RICHAD
Last Name:LEAMY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 HAVISHUM CT
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-6026
Mailing Address - Country:US
Mailing Address - Phone:417-207-7003
Mailing Address - Fax:
Practice Address - Street 1:12409 HAVISHUM CT
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6026
Practice Address - Country:US
Practice Address - Phone:417-207-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102664367500000X
ARC02854367500000X
SC2401367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered