Provider Demographics
NPI:1558697540
Name:ARY, LESLIE A (ACNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:ARY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1720 E REELFOOT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6049
Mailing Address - Country:US
Mailing Address - Phone:013-500-9789
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:1720 E REELFOOT AVE STE 200
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6049
Practice Address - Country:US
Practice Address - Phone:013-500-9789
Practice Address - Fax:901-350-0677
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN14487363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
830341OtherWELLCARE
TN1517153Medicaid
TN6018872OtherBCBS
9625665OtherAETNA
P00805097OtherRAILROAD MEDICARE