Provider Demographics
NPI:1073679536
Name:BROWN, LESLIE A (CNM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2714
Mailing Address - Country:US
Mailing Address - Phone:214-495-9911
Mailing Address - Fax:214-495-9918
Practice Address - Street 1:406 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2714
Practice Address - Country:US
Practice Address - Phone:214-495-9911
Practice Address - Fax:214-495-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657296367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197444601Medicaid
TX8L3651Medicare PIN