Provider Demographics
NPI:1609434620
Name:ROBERTS, LESLIE LEANNE (APRN-FNP C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:LEANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN-FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-0953
Mailing Address - Country:US
Mailing Address - Phone:870-377-4295
Mailing Address - Fax:
Practice Address - Street 1:105 CARLTON DR
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2836
Practice Address - Country:US
Practice Address - Phone:870-377-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006265363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA006265OtherNURSE PRACTITIONER LICENSE