Provider Demographics
NPI:1730636556
Name:ELLIOTT, LESLIE RENEE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RENEE
Last Name:ELLIOTT
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-235-4191
Mailing Address - Fax:423-235-7092
Practice Address - Street 1:260 HIGHWAY 11 E
Practice Address - Street 2:
Practice Address - City:BULLS GAP
Practice Address - State:TN
Practice Address - Zip Code:37711-3416
Practice Address - Country:US
Practice Address - Phone:423-235-4191
Practice Address - Fax:423-235-7092
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily