Provider Demographics
NPI:1710289277
Name:LESKO, AMBER MARIE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:LESKO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 YELLOW STONE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-2562
Mailing Address - Country:US
Mailing Address - Phone:815-275-2421
Mailing Address - Fax:
Practice Address - Street 1:4208 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2462
Practice Address - Country:US
Practice Address - Phone:501-228-7200
Practice Address - Fax:501-228-2285
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered