Provider Demographics
NPI:1528464211
Name:LEAKE, RACHEL KATHERINE ANTHONY
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:KATHERINE ANTHONY
Last Name:LEAKE
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 1:7005 WATERBURY PT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4622
Mailing Address - Country:US
Mailing Address - Phone:731-612-1126
Mailing Address - Fax:
Practice Address - Street 1:1330 CEDAR LN STE 900
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2286
Practice Address - Country:US
Practice Address - Phone:931-455-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19338363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics