Provider Demographics
NPI:1063652717
Name:MYERS, LESLIE MACTAGGART (DNP, APRN, ANP-BC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MACTAGGART
Last Name:MYERS
Suffix:
Gender:F
Credentials:DNP, APRN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MAXWELL AVE
Mailing Address - Street 2:STE 235
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2641
Mailing Address - Country:US
Mailing Address - Phone:864-990-5074
Mailing Address - Fax:
Practice Address - Street 1:104 MAXWELL AVE STE 235
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2641
Practice Address - Country:US
Practice Address - Phone:864-990-5074
Practice Address - Fax:833-405-1939
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA3734363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health