Provider Demographics
NPI:1821595299
Name:ALVAREZ, LESLIE MICHELLE LYNN (MSN, RN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELLE LYNN
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:6421 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4702
Practice Address - Country:US
Practice Address - Phone:817-263-7500
Practice Address - Fax:817-423-4140
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136477363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics