Provider Demographics
NPI:1578623476
Name:LESLIE LUKE, INC.
Entity Type:Organization
Organization Name:LESLIE LUKE, INC.
Other - Org Name:THE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, FNP, WHNP
Authorized Official - Phone:660-562-2273
Mailing Address - Street 1:106 W. EDWARDS
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468
Mailing Address - Country:US
Mailing Address - Phone:660-562-2273
Mailing Address - Fax:660-562-3530
Practice Address - Street 1:106 W. EDWARDS
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468
Practice Address - Country:US
Practice Address - Phone:660-562-2273
Practice Address - Fax:660-562-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicare UPIN
MOPENDINGMedicaid