Individual
DR. MICHELLE JO LEATHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
325 W WALNUT ST, LEBANON, KY 40033-1377
(270) 699-9500
(270) 699-9550
Mailing address
325 W WALNUT ST, LEBANON, KY 40033-1377
(270) 699-9126
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37700
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64064041
—
KY
Enumeration date
11/15/2005
Last updated
02/16/2010
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