Provider Demographics
NPI:1235775990
Name:MCPHATTER, LESLEY (MS, RD, CSR)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:MCPHATTER
Suffix:
Gender:F
Credentials:MS, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1460
Mailing Address - Country:US
Mailing Address - Phone:434-355-7116
Mailing Address - Fax:
Practice Address - Street 1:103 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1460
Practice Address - Country:US
Practice Address - Phone:434-355-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133VN1005X
133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal