Most Relevant Information
Provider Data
| NPI Number: | 1003392416 |
| Provider Name: | MONTOYAE C LEAVY NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 902224 |
Most Important Dates
| Enumeration Date: | 07/18/2018 |
| Last Updated: | 07/18/2018 |
Provider Practice Location
747 INDUSTRIAL PARK RD NE
BROOKHAVEN
MS
396012065
Practice Location Phone/Fax
| Phone: | 6018334111 |
| Fax: |
Provider Mailing Location
122A RICHMOND TRL NE
BROOKHAVEN
MS
396014077
Provider Mailing Phone/Fax
| Phone: | 6014001375 |
| Fax: |