Provider Demographics
NPI:1710115506
Name:MCCOLLUM, LESLIE ELLEN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ELLEN
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MOORHIGH RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-7134
Mailing Address - Country:US
Mailing Address - Phone:662-769-2181
Mailing Address - Fax:
Practice Address - Street 1:6 MOORHIGH RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-7134
Practice Address - Country:US
Practice Address - Phone:662-769-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily