Individual
MRS. DANA JEAN LEATHERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-2084
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-2084
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
547178
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8Y3083
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/06/2007
Last updated
11/18/2008
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