Individual provider Active NPI

Andrew W. Leukhardt, RN, CDOE

  • Diabetes Educator Registered Nurse
  • Providence, RI
National Provider Identifier
1083449169
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
License
RN65957 Issued in RI
Practice address
355 Prairie Ave
Providence, RI 02905-1928
Phone
(401) 444-0570
Fax
(401) 444-0427
NPI assigned
Sep 6, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered Nurse 163WD0400X RN65957 RI Primary

Addresses

Primary practice location

355 Prairie Ave
Providence, RI 02905-1928

Mailing address

375 Allens Ave
Providence, RI 02905-5010
Phone (401) 444-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN65957RIMDDiabetes Educator Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1083449169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 ALLENS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029055010",
            "telephone_number": "401-444-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 PRAIRIE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029051928",
            "telephone_number": "401-444-0570",
            "fax_number": "401-444-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEUKHARDT",
        "first_name": "ANDREW",
        "middle_name": "W.",
        "credential": "RN, CDOE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "RI",
            "license": "RN65957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.