Provider Demographics
NPI:1427200823
Name:MOUNT, LESLIE NICOLE (PA - C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:NICOLE
Last Name:MOUNT
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6964
Mailing Address - Country:US
Mailing Address - Phone:513-420-8195
Mailing Address - Fax:513-420-8824
Practice Address - Street 1:1515 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6703
Practice Address - Country:US
Practice Address - Phone:513-420-8195
Practice Address - Fax:513-420-8824
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical