Provider Demographics
NPI:1376588236
Name:MATHEWSON, LESLIE A (APN (PMHNP))
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:A
Last Name:MATHEWSON
Suffix:
Gender:M
Credentials:APN (PMHNP)
Other - Prefix:MR
Other - First Name:L.
Other - Middle Name:ALBERT
Other - Last Name:MATHEWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN (PMHNP)
Mailing Address - Street 1:10434 JACKSON OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10434 JACKSON OAKS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3293
Practice Address - Country:US
Practice Address - Phone:865-281-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN142095363L00000X
TN10492363LP0808X
SC25390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648105OtherMEDICARE ID TYPE UNSPECIFIED