Basic Information
| Provider Information | |||||||||
| NPI: | 1104277425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEOPARD | ||||||||
| FirstName: | ASHLEIGH | ||||||||
| MiddleName: | WILSON | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 885 | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296200885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643666060 | ||||||||
| FaxNumber: | 8643666062 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 W GREENWOOD ST | ||||||||
| Address2: | SUITE 8A | ||||||||
| City: | ABBEVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296205717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643666060 | ||||||||
| FaxNumber: | 8643666062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2016 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 20285 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 20285 | 01 | SC | SC LICENSE | OTHER | SC85613255 | 01 | SC | PROVIDER PTAN | OTHER |