Provider Demographics
NPI:1689694556
Name:WHITE, LESLIE R (RN FNP)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 S ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-0672
Mailing Address - Country:US
Mailing Address - Phone:432-267-3547
Mailing Address - Fax:
Practice Address - Street 1:1800 SCURRY ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5402
Practice Address - Country:US
Practice Address - Phone:432-268-1711
Practice Address - Fax:432-264-0599
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO1822Medicare UPIN
TX00977WMedicare ID - Type Unspecified