Provider Demographics
NPI:1225046055
Name:LESLIE, NANCY ADAMS (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ADAMS
Last Name:LESLIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HWY 47
Mailing Address - Street 2:STE 4600
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-3260
Mailing Address - Country:US
Mailing Address - Phone:979-774-1000
Mailing Address - Fax:979-776-1211
Practice Address - Street 1:8441 STATE HWY 47
Practice Address - Street 2:STE 4600
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-3260
Practice Address - Country:US
Practice Address - Phone:979-774-1000
Practice Address - Fax:979-776-1211
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22746103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033619001Medicaid
TX86866AOtherBCBS PROVIDER NO.
TX8B8798Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
TX86866AOtherBCBS PROVIDER NO.