Provider Demographics
NPI:1215041843
Name:LINDSEY, LESLIE SHARRON (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SHARRON
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4020
Mailing Address - Country:US
Mailing Address - Phone:806-273-5552
Mailing Address - Fax:806-274-9619
Practice Address - Street 1:100 S MCGEE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4020
Practice Address - Country:US
Practice Address - Phone:806-273-5552
Practice Address - Fax:806-274-9619
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-01-22
Deactivation Date:2007-07-18
Deactivation Code:
Reactivation Date:2008-03-10
Provider Licenses
StateLicense IDTaxonomies
TX233944163WG0000X, 363LF0000X
KS1465952031163WG0000X
KS44421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063663101Medicaid
TX063663101Medicaid