Provider Demographics
NPI:1699457440
Name:VESTAL, LEAH CHAMBLIN
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:CHAMBLIN
Last Name:VESTAL
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 1:1020 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-6870
Mailing Address - Country:US
Mailing Address - Phone:336-831-3453
Mailing Address - Fax:
Practice Address - Street 1:211 S TRADD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5859
Practice Address - Country:US
Practice Address - Phone:828-655-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC306708163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult