Individual
KATHLEEN ANNE LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2015022172
MO
207L00000X
Anesthesiology Physician
Primary
2021-00414
NC
207L00000X
Anesthesiology Physician
D54438
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061691501
—
MD
01
—
2015022172
LICENSE
MO
01
—
50503412
TRICARE CHAMPUS
—
01
—
601285800
FECA
—
Enumeration date
05/24/2006
Last updated
07/29/2021
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