Provider Demographics
NPI:1457663254
Name:DIECKHOFF, LESLIE GRAVES (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:GRAVES
Last Name:DIECKHOFF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 EASTPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4185
Mailing Address - Country:US
Mailing Address - Phone:502-339-6550
Mailing Address - Fax:502-339-6501
Practice Address - Street 1:3012 EASTPOINT PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4185
Practice Address - Country:US
Practice Address - Phone:502-339-6550
Practice Address - Fax:502-339-6501
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5042P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health