Provider Demographics
NPI:1265511315
Name:ABBOTT, LESLEY P (DO)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:P
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SUNSET DROVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2681
Mailing Address - Country:US
Mailing Address - Phone:606-232-9179
Mailing Address - Fax:
Practice Address - Street 1:2121 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-2615
Practice Address - Country:US
Practice Address - Phone:606-833-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02808207Q00000X
KYKY020803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01-13293OtherCHA PIN
KYP00157257OtherRAILROAD MEDICARE PIN
KY000000339034OtherBLUE CROSS SHIELD PIN
KY000000606035OtherANTHEM BCBS
OH2509084Medicaid
KY64081524Medicaid
KYP00157257OtherRAILROAD MEDICARE PIN
KYI15014Medicare UPIN
OH2509084Medicaid