Provider Demographics
NPI:1114400256
Name:KENNEDY, LESLIE MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:THEISEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1735 S PUBLIC RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7093
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:
Practice Address - Street 1:8510 BRYANT ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3845
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:720-565-4130
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704347248363LF0000X
COAPN0997082NP363LF0000X
IL209018394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily