Provider Demographics
NPI:1689099608
Name:SKAGGS, LESLIE (RN, AGNP-BC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:RN, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 KELLER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1628
Mailing Address - Country:US
Mailing Address - Phone:817-431-9199
Mailing Address - Fax:888-690-2833
Practice Address - Street 1:7151 COLLEYVILLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8030
Practice Address - Country:US
Practice Address - Phone:817-416-1931
Practice Address - Fax:817-488-8527
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX763534363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology