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Individual

MRS. IVY GERALYN DE LEON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP-BC, FNP-C

Contact information

Practice address
378 WILLIAMSON RD STE 204, MOORESVILLE, NC 28117-5917
(704) 978-8334
(980) 399-2600
Mailing address
103 BILLINSGATE CT, MOORESVILLE, NC 28117-6702
(704) 880-1466
(704) 880-1466

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5004501
NC
363LF0000X
Family Nurse Practitioner
182897
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
182897
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5004501
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2594567D
MEDICARE PTAN, INDIVIDUAL
NC
05
7000658
NC
Enumeration date
08/26/2009
Last updated
05/14/2026
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