Provider Demographics
NPI:1841478120
Name:HOUSTON, LESLIE H (NP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:H
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BANK FIRST DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-6611
Mailing Address - Country:US
Mailing Address - Phone:601-624-2398
Mailing Address - Fax:769-572-7926
Practice Address - Street 1:225 BANK FIRST DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6611
Practice Address - Country:US
Practice Address - Phone:601-992-0004
Practice Address - Fax:769-572-7926
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07520371Medicaid