Individual
SHELLEY S LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
820 MANGUM AVE, MENDENHALL, MS 39114
(601) 847-5111
(601) 847-3060
Mailing address
820 MANGUM AVE, MENDENHALL, MS 39114
(601) 847-5111
(601) 847-3060
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R863242
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00476391
—
MS
Enumeration date
08/27/2009
Last updated
08/06/2025
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