Provider Demographics
NPI:1831723311
Name:LEESON, BRENDA JEAN
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:LEESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARLOW, KROUT
Mailing Address - Street 1:7839 N LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-7631
Mailing Address - Country:US
Mailing Address - Phone:816-517-4339
Mailing Address - Fax:
Practice Address - Street 1:8951 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3231
Practice Address - Country:US
Practice Address - Phone:816-443-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020003744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner