Provider Demographics
NPI:1205448651
Name:STELLY, LESLIE B (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:STELLY
Suffix:
Gender:F
Credentials:APRN, FNP-C
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 122539 DEPT 2539
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:708 E RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:WELSH
Practice Address - State:LA
Practice Address - Zip Code:70591-4844
Practice Address - Country:US
Practice Address - Phone:337-734-4500
Practice Address - Fax:337-734-4400
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily