Provider Demographics
NPI:1710301361
Name:BUMPAS, LESLIE (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BUMPAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-3663
Mailing Address - Country:US
Mailing Address - Phone:423-500-0266
Mailing Address - Fax:423-500-4280
Practice Address - Street 1:850 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3663
Practice Address - Country:US
Practice Address - Phone:423-500-0266
Practice Address - Fax:423-500-4280
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1710301361Other1710301361