Provider Demographics
NPI:1720763816
Name:JEFFRIES, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:JEFFRIES
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 1:2315 DAVIS BEND RD
Mailing Address - Street 2:
Mailing Address - City:CANMER
Mailing Address - State:KY
Mailing Address - Zip Code:42722-9404
Mailing Address - Country:US
Mailing Address - Phone:270-528-2333
Mailing Address - Fax:
Practice Address - Street 1:2315 DAVIS BEND RD
Practice Address - Street 2:
Practice Address - City:CANMER
Practice Address - State:KY
Practice Address - Zip Code:42722-9404
Practice Address - Country:US
Practice Address - Phone:270-528-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1085999163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse