Leach, Mary Kay

Leach, Mary Kay is an individual health care provider with primary practice located at 1000 Mar Walt Dr Internal Medicine Department, Fort Walton Beach FL 32547-6708. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Leach, Mary Kay can be contacted via phone (850) 863-8202.

Contact Information

Primary practice address
1000 Mar Walt Dr Internal Medicine Department Fort Walton Beach FL 32547-6708
Phone: (850) 863-8202
Fax: (850) 862-6148
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ARNP9196496 Florida

Profile Details

NPI number 1235199134
LBN Legal business name Leach, Mary Kay
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2006
Last updated May 19th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235199134 NPPES
Florida MEDICAID 305445400

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