Provider Demographics
NPI:1952733651
Name:BROWN, LESLIE HICKEY (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:HICKEY
Last Name:BROWN
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 1:120 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5281
Mailing Address - Country:US
Mailing Address - Phone:504-371-6550
Mailing Address - Fax:504-371-6555
Practice Address - Street 1:441 WALL BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7723
Practice Address - Country:US
Practice Address - Phone:504-371-6550
Practice Address - Fax:504-371-6555
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA234050Medicaid
MS05682530Medicaid
LA234050Medicaid