Provider Demographics
NPI:1386252625
Name:NELSON, LEAH SIMONE (APRN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SIMONE
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CLAUDE DR APT 2125
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5748
Mailing Address - Country:US
Mailing Address - Phone:501-747-8694
Mailing Address - Fax:
Practice Address - Street 1:8000 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4136
Practice Address - Country:US
Practice Address - Phone:469-742-9950
Practice Address - Fax:972-548-9005
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004535363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology