Provider Demographics
NPI:1801899588
Name:PHELPS, LESLIE C (APRN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:C
Last Name:PHELPS
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 1:3346 PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4551
Mailing Address - Country:US
Mailing Address - Phone:270-685-1066
Mailing Address - Fax:270-713-0227
Practice Address - Street 1:3346 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4551
Practice Address - Country:US
Practice Address - Phone:270-685-1066
Practice Address - Fax:270-713-0227
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-11-10
Deactivation Date:2005-11-07
Deactivation Code:
Reactivation Date:2006-10-27
Provider Licenses
StateLicense IDTaxonomies
KY3004401P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30457Medicare UPIN
0268507Medicare ID - Type Unspecified