Provider Demographics
NPI:1023010477
Name:LESKO, LAURA KAY (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:LESKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:COMSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213966367500000X
TX721570367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157825401Medicaid
TX8848UGOtherBCBS TX
TX181526804Medicaid
TX181526805Medicaid
TX181526801Medicaid
TXP00754978OtherRR MEDICARE
AL009965595Medicaid
FL306467100Medicaid
TX86438UOtherBCBS
FLG3545OtherBLUECROSS & BLUESHIELD
TX181526802Medicaid
TX181526808Medicaid
AL59173246OtherBLUECROSS & BLUESHIELD
TX86438UOtherBCBS
FLG3545ZMedicare ID - Type Unspecified
TX157825401Medicaid
TX8G6502Medicare PIN