Provider Demographics
NPI:1568759553
Name:KIMPLER, LESLIE RENEE (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RENEE
Last Name:KIMPLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:RENEE
Other - Last Name:OXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 5
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-8715
Mailing Address - Fax:401-444-8781
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-8715
Practice Address - Fax:401-444-8781
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO012572084N0400X
KS94077362084N0400X
SC407662084N0400X
TXQ89262084P0800X, 2084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00106WOtherGRP MEDICARE PTAN
TX153449704OtherGRP MEDICAID TPI #
TX0035TDOtherBCBSTX GRP PROVIDER RECORD #