Provider Demographics
NPI:1912417205
Name:LESLIE, CHRISTINE MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E HILL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2565
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:1410 TUSCULUM BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5822
Practice Address - Country:US
Practice Address - Phone:423-639-0243
Practice Address - Fax:423-639-0628
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034996Medicaid
TNT00969AOtherMEDICARE