Provider Demographics
NPI:1295436244
Name:LEAVITT, ABALONIA ROSE (CD, MSP, CPM, NRP)
Entity type:Individual
Prefix:DR
First Name:ABALONIA
Middle Name:ROSE
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:CD, MSP, CPM, NRP
Other - Prefix:DR
Other - First Name:ABBEY
Other - Middle Name:
Other - Last Name:LEAVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD,MSP,CPM,NRC
Mailing Address - Street 1:5636 OLD HICKORY BLVD APT 720
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3099
Mailing Address - Country:US
Mailing Address - Phone:615-928-0641
Mailing Address - Fax:
Practice Address - Street 1:5636 OLD HICKORY BLVD APT 720
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3099
Practice Address - Country:US
Practice Address - Phone:954-282-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN241208174N00000X, 175M00000X
175L00000X, 175M00000X
TN1295436244176B00000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, Lay
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopath
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1295436244Medicaid
GA1295436244OtherLAY MIDWIFE/DOULA
TN1295436244OtherLAY MIDWIFE/DOULA