Provider Demographics
NPI:1932186970
Name:ROBERTS, LESLEY YOUNG (ADVANCED PRACTICE NU)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:YOUNG
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 DOWELL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2441
Mailing Address - Country:US
Mailing Address - Phone:865-970-9800
Mailing Address - Fax:865-374-7317
Practice Address - Street 1:1451 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:865-374-7317
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN140015363LP0808X
TNAPN8412363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928736Medicaid
TN3928736Medicaid
Q14951Medicare UPIN
TN3928736Medicaid