Provider Demographics
NPI:1053820217
Name:DAVIS, LESLEY PAGE (CRNP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:PAGE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:5005 OSCAR BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3698
Mailing Address - Country:US
Mailing Address - Phone:205-343-2225
Mailing Address - Fax:
Practice Address - Street 1:5005 OSCAR BAXTER DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3698
Practice Address - Country:US
Practice Address - Phone:205-343-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily