Provider Demographics
NPI:1932455276
Name:LEONARD, KATIE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELIZABETH
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:LEONARD
Other - Last Name:CAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3115 COLLEGE PARK DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4001
Mailing Address - Country:US
Mailing Address - Phone:936-321-5030
Mailing Address - Fax:936-271-5033
Practice Address - Street 1:3115 COLLEGE PARK DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4001
Practice Address - Country:US
Practice Address - Phone:936-321-5030
Practice Address - Fax:936-271-5033
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039894208000000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program