Provider Demographics
NPI:1447526033
Name:SKINNER- SAPP, LEALIA (NP)
Entity type:Individual
Prefix:MS
First Name:LEALIA
Middle Name:
Last Name:SKINNER- SAPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LEALIA
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7 LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2783
Mailing Address - Country:US
Mailing Address - Phone:318-789-8970
Mailing Address - Fax:
Practice Address - Street 1:7 LESLIE LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2783
Practice Address - Country:US
Practice Address - Phone:318-789-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN072089-AP06510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2194097Medicaid