Provider Demographics
NPI:1801066808
Name:LESLIE, JEAN M (APRN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:LESLIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4453
Mailing Address - Country:US
Mailing Address - Phone:870-741-8559
Mailing Address - Fax:870-741-8423
Practice Address - Street 1:306 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4453
Practice Address - Country:US
Practice Address - Phone:870-741-8559
Practice Address - Fax:870-741-8423
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03155ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA03155ANPOtherAPN LICENSE
AR129735729Medicaid
AR136428729Medicaid
AR199554758Medicaid
AR129735729Medicaid
AR136428729Medicaid
AR5B746Medicare PIN
AR56965Medicare PIN
AR040072Medicare Oscar/Certification
AR129734729Medicaid
AR043480Medicare Oscar/Certification
AR043489Medicare Oscar/Certification
AR136428729Medicaid
AR043457Medicare Oscar/Certification
AR043456Medicare Oscar/Certification