Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary K Leavery, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1063520005

Mary K Leavery, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Winston Salem, North Carolina. Graduated from State University of New York at Buffalo School of Medicine in 1995, 31 years ago. Practices with Medical Park Hospital LLC, a 109-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in North Carolina, New York and South Carolina.

Years since qualifying
31
Trained at
State University of New York at Buffalo School of Medicine
Licensed in
NC, NY, SC
In the registry since
2006
Specialties on file
3
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103
Phone: (336) 768-3212
Fax: (336) 768-9019
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 830 Washington St, Watertown, NY 13601-4034 — (315) 785-4313
  • 830 Washington St, Watertown, NY 13601-4034 — (315) 785-4313

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 45453 (NC)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 993 (SC)
Registered Nurse Taxonomy 163W00000X · Licence 360053-1 (NY)

Record details

NPI number1063520005
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNA
Sole proprietorNo
NPI enumeratedAugust 29, 2006
Last updated in NPPESOctober 28, 2020
Certification dateOctober 28, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolSTATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
Graduated 1995 (31 years in practice)
Group practice Medical Park Hospital Llc — 109 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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