Provider Demographics
NPI:1487087664
Name:LEONARD, JESSIE FUENTES (CRNP)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:FUENTES
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:ONDINA
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1401 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404
Practice Address - Country:US
Practice Address - Phone:717-812-7000
Practice Address - Fax:717-767-8985
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013065363LF0000X
MDR205536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3002240OtherHIGHMARK BLUE SHIELD-FREEDOM BLUE
PA310633EZ3Medicare PIN