Provider Demographics
NPI:1235630641
Name:BOSSE, LESLEY ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:ANN
Last Name:BOSSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:LESLEY
Other - Middle Name:ANN
Other - Last Name:SERVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1724 STATE RD UNIT 6B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2842
Practice Address - Country:US
Practice Address - Phone:843-606-7100
Practice Address - Fax:843-606-7101
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5030Medicaid