Provider Demographics
NPI:1487052098
Name:HENDRIX, LEAH C (FNP-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:C
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-3311
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-365-8709
Practice Address - Fax:217-383-4226
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015878363LF0000X
NC244813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487052098Medicaid
SCNP3097Medicaid
NCNCM462DMedicare PIN
SCNP3097Medicaid
NC1487052098Medicaid
NCNCM462AMedicare PIN