Provider Demographics
NPI:1740281468
Name:KLEIN, LESLIE MCQUAY (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MCQUAY
Last Name:KLEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-9961
Mailing Address - Country:US
Mailing Address - Phone:865-406-1264
Mailing Address - Fax:980-495-5310
Practice Address - Street 1:1001 MOREHEAD SQUARE DR STE 195
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4213
Practice Address - Country:US
Practice Address - Phone:980-218-9496
Practice Address - Fax:980-495-5310
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91981Medicare UPIN