Provider Demographics
NPI:1376975797
Name:POWELL, LESLIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1135
Mailing Address - Country:US
Mailing Address - Phone:804-269-1576
Mailing Address - Fax:
Practice Address - Street 1:1855 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1135
Practice Address - Country:US
Practice Address - Phone:614-257-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017888363LP0808X
VA0024192191363LP0808X
VT101.0137517TELE363LP0808X
OHCNP14973363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health