Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2346P | KY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3002346 | KY |
NPI | 1265579239 |
---|---|
Provider Name | Mrs. Wilma Leslie |
First Address | Prestonsburg, KY 41653-0406 |
Second Address | Harold, KY 41635-7064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78001898 | (05) | KY |
S72168 | (02) | KY |