Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN150142 | GA |
NPI | 1003092834 |
---|---|
Provider Name | Mrs. Leigh Ann Youngblood - West |
First Address | Columbus, GA 31904-6878 |
Second Address | Columbus, GA 31904-6878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2008 |
Last Update Date | 14/08/2012 |