Provider Demographics
NPI:1588132096
Name:LEONARD, KRISTINA MARIE (AGACNP - BC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:AGACNP - BC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8632 E THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1853
Mailing Address - Country:US
Mailing Address - Phone:480-338-0978
Mailing Address - Fax:
Practice Address - Street 1:8632 E THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1853
Practice Address - Country:US
Practice Address - Phone:480-338-0978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218593363L00000X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology