Provider Demographics
NPI:1316435415
Name:RICHARDSON, LEIGH ANN (FNPC)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:ELK CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24326-2100
Mailing Address - Country:US
Mailing Address - Phone:276-233-4304
Mailing Address - Fax:
Practice Address - Street 1:5261 CARROLLTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3034
Practice Address - Country:US
Practice Address - Phone:276-238-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine