Provider Demographics
NPI:1619667284
Name:WILLIAMS, LESLIE ROSE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 SAGEWOOD CV
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-6632
Mailing Address - Country:US
Mailing Address - Phone:501-206-4466
Mailing Address - Fax:
Practice Address - Street 1:718 SAGEWOOD CV
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-6632
Practice Address - Country:US
Practice Address - Phone:501-206-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health