Provider Demographics
NPI:1134868193
Name:MYRICK, LESLEY
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:MYRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5237
Mailing Address - Country:US
Mailing Address - Phone:770-317-9651
Mailing Address - Fax:
Practice Address - Street 1:1008 E MCDOWELL RD STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2603
Practice Address - Country:US
Practice Address - Phone:602-358-8588
Practice Address - Fax:602-688-6991
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ303923363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health