Provider Demographics
NPI:1245281013
Name:GUTHRIE, LESLEY LATAISHA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:LATAISHA
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 VIRGINIA WAY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4962
Mailing Address - Country:US
Mailing Address - Phone:501-368-0337
Mailing Address - Fax:
Practice Address - Street 1:161 VIRGINIA WAY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4962
Practice Address - Country:US
Practice Address - Phone:501-368-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCO1581 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161320001Medicaid
AR5Y816OtherBLUE CROSS/BLUE SHIELD