Leah Renee Komisak

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT0506770 Issued in NV

Practice address

4269 Tyndall Ave BLDG 282
Nellis Afb, NV 89191-6074

Phone

(810) 358-3817

NPI assigned

Jun 9, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1508481110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4269 TYNDALL AVE BLDG 282",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916074",
            "telephone_number": "810-358-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4269 TYNDALL AVE BLDG 282",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916074",
            "telephone_number": "810-358-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMISAK",
        "first_name": "LEAH",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "HI",
            "license": "AT-352",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NH",
            "license": "1457",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NV",
            "license": "AT0506770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Knowlton, DO
• James Clayborn Knudson, DPM
• Victoria Christiane Koehler
• Eric J Koenig, DMD
• Debra A Koenigsberger, MD
• Ross Konicke
• Ritesh Kool, M.D.
• Michael A Koroscil, M.D.
• Lester Nelson Krawitt, MD
• Kyle Matthew Kreft, MD

• Athletic Trainer in Nellis Afb, NV
• Providers in Nellis Afb, NV by specialty
• Athletic Trainer in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.