Provider Demographics
NPI:1881955995
Name:LESLIE, JESSA MCKENZIE (APN)
Entity type:Individual
Prefix:
First Name:JESSA
Middle Name:MCKENZIE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 MEDITERRANEAN DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3154
Mailing Address - Country:US
Mailing Address - Phone:815-899-0001
Mailing Address - Fax:815-899-0002
Practice Address - Street 1:1680 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3154
Practice Address - Country:US
Practice Address - Phone:815-899-0001
Practice Address - Fax:815-899-0002
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009458363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics