Provider Demographics
NPI:1639701022
Name:LESLIE, RYAN NIKOLAI (APRN-ACP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NIKOLAI
Last Name:LESLIE
Suffix:
Gender:M
Credentials:APRN-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 HENDRIX AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-2630
Mailing Address - Country:US
Mailing Address - Phone:501-747-3900
Mailing Address - Fax:
Practice Address - Street 1:1217 HENDRIX AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2630
Practice Address - Country:US
Practice Address - Phone:501-255-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR090467163WP0809X
AR124003363LP0808X
KS53-80978-011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult