Provider Demographics
NPI:1396556437
Name:KILE, LEEANNA
Entity type:Individual
Prefix:
First Name:LEEANNA
Middle Name:
Last Name:KILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-1153
Mailing Address - Country:US
Mailing Address - Phone:580-369-0482
Mailing Address - Fax:
Practice Address - Street 1:400 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3811
Practice Address - Country:US
Practice Address - Phone:580-369-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education