Provider Demographics
NPI:1376054601
Name:ROSS, LESLEY (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MISS
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 GLEN ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5387
Mailing Address - Country:US
Mailing Address - Phone:214-868-3665
Mailing Address - Fax:
Practice Address - Street 1:1405 GLEN ELLEN CT
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5387
Practice Address - Country:US
Practice Address - Phone:214-868-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135395363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics