Provider Demographics
NPI:1497017404
Name:LOWE, LESLEE MICHELE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LESLEE
Middle Name:MICHELE
Last Name:LOWE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LESLEE
Other - Middle Name:MICHELE
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1101 MORGAN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3949
Practice Address - Country:US
Practice Address - Phone:870-335-9483
Practice Address - Fax:870-335-9487
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004153363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205837758Medicaid
AR5HH99OtherBCBS