Provider Demographics
NPI:1215993878
Name:SEGLER, LEESA L (CRNA)
Entity type:Individual
Prefix:
First Name:LEESA
Middle Name:L
Last Name:SEGLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1960
Mailing Address - Country:US
Mailing Address - Phone:270-885-1640
Mailing Address - Fax:270-889-0628
Practice Address - Street 1:103 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1960
Practice Address - Country:US
Practice Address - Phone:270-885-1640
Practice Address - Fax:270-889-0628
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2325367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74023250Medicaid
KY74023250Medicaid
S35941Medicare UPIN