Individual
KRISTINA R LEAVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2516 E DUPONT RD, FORT WAYNE, IN 46825-1608
(260) 458-3755
(260) 458-3756
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000742A
IN
Other
Enumeration date
02/14/2007
Last updated
10/13/2020
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