| Doctor Name: | MRS. LEAH MARANDA MARTIN |
| NPI Number: | 1033329701 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | A01850 |
| Business Practice Address: | 1014 Harkrider St Suite B Conway, AR - 720324404 |
| Business Phone Number: | 5013277100 |
| Business Fax Number: | 5012799011 |
| Mailing Address: | 275 Cherry Ln, RUSSELLVILLE |
| State: | AR |
| Postal Code: | 728022117 |
| Phone Number: | 4792843029 |
| Fax Number: | 4792842244 |
| NPI Enumeration Date: | 05/23/2007 |
| NPI Last Update Date: | 10/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A01850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |