MRS. JACQUELYN M LEAK-GILLISPIE (NPI# 1831255330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831255330 |
| Entity Type | Individual |
| Full Name | MRS. JACQUELYN M LEAK-GILLISPIE |
| Other Name | JACQUELYN M LEAK |
| Credential | NP-C |
| Practice Address |
920 Church St N Concord NC 28025-2927 |
| Mailing Address |
804 Scott Nixon Memorial Dr Augusta GA 30907-2464 |
| Practice Telephone | 7044031430 |
| Practice Fax Number | 7044031158 |
| Mailing Telephone | 8003944445 |
| Mailing Fax Number | 7066501034 |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2014-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0000X |
Registered Nurse Specialization: Pain Management |
5002506 | NC | Nursing Service Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
5002506 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | ML1537363 | 01 |
| Street Address |
920 CHURCH ST N |
| City | CONCORD |
| State | NC |
| Zip Code | 28025-2927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386647808 | Leanne Smith | Nurse Anesthetist, Certified Registered | 920 Church St N, Concord, NC 28025-2927 | 2005-05-30 |
| 1104431014 | Mrunmayee Manohar Shete | Genetic Counselor, MS | 920 Church St N, Concord, NC 28025-2927 | 2020-09-09 |
| 1083232144 | Sarah Elizabeth Garfinkle | Pharmacist | 920 Church St N, Concord, NC 28025-2927 | 2020-07-06 |
| 1184248924 | Dustin Edwards | Physician Assistant | 920 Church St N, Concord, NC 28025-2927 | 2020-06-06 |
| 1396372892 | Zaki Krishan Faraz Dard | Student in an Organized Health Care Education/Training Program | 920 Church St N, Concord, NC 28025-2927 | 2020-03-24 |
| 1477185825 | Tonda Vanderburg Proulx | Nurse Practitioner | 920 Church St N, Concord, NC 28025-2927 | 2020-02-04 |
| 1245870724 | Caroline A. Miller | Nurse Anesthetist, Certified Registered | 920 Church St N, Concord, NC 28025-2927 | 2020-01-13 |
| 1316585417 | Adam Beam | Nurse Anesthetist, Certified Registered | 920 Church St N, Concord, NC 28025-2927 | 2019-12-19 |
| 1114565496 | Kendal Brianne Mcmakin | Nurse Anesthetist, Certified Registered | 920 Church St N, Concord, NC 28025-2927 | 2019-12-17 |
| 1962053561 | Amanda Huneycutt Helms | Nurse Practitioner | 920 Church St N, Concord, NC 28025-2927 | 2019-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053910729 | Renewed Mindset Therapeutic Services, Pllc | Social Worker | 349 Copperfield Blvd Suite L #334, Concord, NC 28025 | 2020-10-22 |
| 1194284380 | Carolinas Physicians Network Inc | Internal Medicine | 610 Alfred Brown Jr. Court, Concord, NC 28025 | 2019-03-18 |
| 1164913596 | Damarius Raymond Faggart | Counselor | 503 Amhurst Drive, Concord, NC 28025 | 2018-05-22 |
| 1437677085 | Kathryn Emily Kanauer | Counselor | 280 Executive Park Dr Ne, Concord, NC 28025 | 2017-09-05 |
| 1649794439 | Foster Health & Homecare, LLC | Home Health | 363 Church Street North, Suite 260-i, Concord, NC 28025 | 2017-08-02 |
| 1326569336 | Jessie Leigh Tilley-compton | Social Worker | 371 Amhurst St Sw, Concord, NC 28025 | 2017-06-29 |
| 1609305663 | Sarah Katherine Thompson | Licensed Practical Nurse | 248 Executive Park Dr, Concord, NC 28025 | 2017-06-05 |
| 1023463098 | Kiera Brown | Social Worker | 219 Lephillip Court, Concord, NC 28025 | 2016-04-27 |
| 1992169445 | Brittiny N. Ingram Vanterpool | Counselor | 250 Branchview Dr Sw, Concord, NC 28025 | 2016-04-11 |
| 1215399852 | The Charlotte-mecklenburg Hospital Authority | Clinic/Center | 840 Warren C. Coleman Blvd, Concord, NC 28025 | 2016-03-23 |
| Find all providers in zip 28025 | ||||
| Taxonomy Code | 163WP0000X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Pain Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194940288 | Jo Anne H Eure | Registered Nurse | 1970 W Arlington Blvd Ste C, Greenville, NC 27834-5783 | 2007-04-16 |
| 1548821077 | Angelica Adkins Charles | Registered Nurse | 230 N Winstead Ave, Rocky Mount, NC 27804-2225 | 2019-06-25 |
| 1508385428 | Pope Medical Associates Inc | Registered Nurse | 172 W Independence Blvd, Mount Airy, NC 27030-3566 | 2017-09-12 |
| 1003362666 | Ramona Irabor | Registered Nurse | Dumc Box 3677, Durham, NC 27710-3677 | 2016-09-01 |
| 1124486832 | Pope Medical Associates Inc | Registered Nurse | 1908 Caudle Dr, Suite 103, Mount Airy, NC 27030-4321 | 2016-02-09 |
Please comment or provide details below to improve the information on MRS. JACQUELYN M LEAK-GILLISPIE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.