Provider Demographics
NPI:1053317909
Name:TUTT, LESLIE KINSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:KINSEY
Last Name:TUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:KINSEY
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-780-2497
Mailing Address - Fax:270-780-0481
Practice Address - Street 1:201 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1759
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-783-3779
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY387162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64084437Medicaid
KY64084437Medicaid
KY64084437Medicaid