Provider Demographics
NPI:1659612299
Name:TEEL, LESLEY DALE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:DALE
Last Name:TEEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6041
Mailing Address - Country:US
Mailing Address - Phone:334-275-9595
Mailing Address - Fax:706-223-1934
Practice Address - Street 1:2123 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6041
Practice Address - Country:US
Practice Address - Phone:334-275-9595
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily