Provider Demographics
NPI:1619901212
Name:BROWN, LESLIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:MATHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:450 S KITSAP BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3738
Mailing Address - Country:US
Mailing Address - Phone:360-895-0216
Mailing Address - Fax:360-895-7919
Practice Address - Street 1:450 S KITSAP BLVD STE 230
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3738
Practice Address - Country:US
Practice Address - Phone:360-895-0216
Practice Address - Fax:360-895-7919
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004805363LP0200X
WARN00118220363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00118220OtherRN
WAAP30004805OtherAP
WA9624974Medicaid
WA9624974Medicaid
WA9624974Medicaid
WAAB08165Medicare PIN