Provider Demographics
NPI:1922338862
Name:LEONARD-JEAN CHARLES, ANTOINETTE (CPT, CN, OCP)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:LEONARD-JEAN CHARLES
Suffix:
Gender:F
Credentials:CPT, CN, OCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 COBBLESTONE LNDG
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7470
Mailing Address - Country:US
Mailing Address - Phone:917-969-5274
Mailing Address - Fax:
Practice Address - Street 1:276 COBBLESTONE LNDG
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7470
Practice Address - Country:US
Practice Address - Phone:917-969-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54992932255A2300X
174H00000X, 246RP1900X, 251K00000X, 261QH0100X, 261QR1100X, 374J00000X, 172V00000X, 133NN1002X, 156F00000X, 171400000X, 1744R1102X, 1744R1103X
5499295133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No251K00000XAgenciesPublic Health or Welfare
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No374J00000XNursing Service Related ProvidersDoula
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No171400000XOther Service ProvidersHealth & Wellness Coach
No1744R1102XOther Service ProvidersSpecialistResearch Study
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder