Provider Demographics
NPI:1649575978
Name:MATHIS, LESLEY MARIE (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:MARIE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 MAYFAIR CT
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-7337
Mailing Address - Country:US
Mailing Address - Phone:615-364-7978
Mailing Address - Fax:
Practice Address - Street 1:7505 MAYFAIR CT
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-7337
Practice Address - Country:US
Practice Address - Phone:615-364-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014712363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care