Provider Demographics
NPI:1720199276
Name:LEONARD, JENNIFER LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1553
Mailing Address - Country:US
Mailing Address - Phone:712-249-4910
Mailing Address - Fax:
Practice Address - Street 1:600 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1553
Practice Address - Country:US
Practice Address - Phone:160-526-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA120565363L00000X
NE115179363L00000X
SD454363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6829764Medicaid
SD6829762Medicaid
SD6829763Medicaid
SD6829760Medicaid
SD6829763Medicaid
SDS102042Medicare PIN