Provider Demographics
NPI:1649381112
Name:ROGERS, LESLIE C (BSN, MSN, APRN, FNPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BSN, MSN, APRN, FNPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:CAROL
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, MSN, APRN, FNPC
Mailing Address - Street 1:125 E MAXWELL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2678
Mailing Address - Country:US
Mailing Address - Phone:859-257-7171
Mailing Address - Fax:859-257-8232
Practice Address - Street 1:125 E MAXWELL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2678
Practice Address - Country:US
Practice Address - Phone:859-257-7171
Practice Address - Fax:859-257-8232
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003774363LF0000X
KY1098680163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78902897Medicaid
KY78902897Medicaid
KY0720701Medicare ID - Type Unspecified