Provider Demographics
NPI:1003792011
Name:PHILLIPS, LEANNA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:MICHELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9991 BANKSTON RD
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-1724
Mailing Address - Country:US
Mailing Address - Phone:205-639-4883
Mailing Address - Fax:
Practice Address - Street 1:3400 HIGHWAY 78 E STE 321
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8951
Practice Address - Country:US
Practice Address - Phone:205-226-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-137809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily