Provider Demographics
NPI:1528374097
Name:WHITE, LESLEY K (APRN)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:K
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LESLEY
Other - Middle Name:K
Other - Last Name:MOTTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:9800 SHELBYVILLE RD STE 220
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2992
Practice Address - Country:US
Practice Address - Phone:502-429-8585
Practice Address - Fax:502-429-6157
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006578363L00000X, 363L00000X
IN71003377A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201009810Medicaid
KY7100142640Medicaid
INP00979348OtherRAILROAD MEDICARE
IN201009810Medicaid
KY7100142640Medicaid
KY50030487OtherPASSPORT
INM400026383Medicare PIN
KY7100142640Medicaid