Provider Demographics
NPI:1164701173
Name:LEFFLER, LESLIE WALTON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:WALTON
Last Name:LEFFLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 BRECKENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1409
Mailing Address - Country:US
Mailing Address - Phone:502-893-0159
Mailing Address - Fax:
Practice Address - Street 1:108 W DAISY LN
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4537
Practice Address - Country:US
Practice Address - Phone:812-945-3557
Practice Address - Fax:812-206-1784
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007082363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007082OtherAPRN LICENSE NUMBER FROM KY BOARD OF NURSING
KY7100196000Medicaid