Basic Information
| Provider Information | |||||||||
| NPI: | 1669924296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEATH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 PONDER CT | ||||||||
| Address2: | STE 104 | ||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404229050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592364852 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UK DIVISION OF HOSPITAL MEDICINE | ||||||||
| Address2: | 800 ROSE STREET, MN604 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405367001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236047 | ||||||||
| FaxNumber: | 8592573873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 3010834 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.