Provider Demographics
NPI:1659419349
Name:VERNOR, LESLEY L (C-PNP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:L
Last Name:VERNOR
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 POND HILL ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231
Mailing Address - Country:US
Mailing Address - Phone:210-249-5020
Mailing Address - Fax:210-494-2209
Practice Address - Street 1:4114 POND HILL ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-249-5020
Practice Address - Fax:210-494-2209
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111986363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F10116OtherMEDICARE
TX190304904OtherCSHCN
TX190304903Medicaid