Provider Demographics
NPI:1528554532
Name:MCLAMB, LESLIE FAHY (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:FAHY
Last Name:MCLAMB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:KIM
Other - Last Name:KASTLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8013
Mailing Address - Fax:843-663-8166
Practice Address - Street 1:945 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21995OtherSC LICENSE