Provider Demographics
NPI:1790060978
Name:PROCTOR, LESLIE KAY (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:KAY
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 RIDGETOP BND
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7479
Mailing Address - Country:US
Mailing Address - Phone:512-468-5822
Mailing Address - Fax:
Practice Address - Street 1:425 RIDGETOP BND
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7479
Practice Address - Country:US
Practice Address - Phone:512-468-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered