Provider Demographics
NPI:1962554352
Name:RICHEY-SMITH, LESLEY RENAYE (DPM)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:RENAYE
Last Name:RICHEY-SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 CORINTH PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-1316
Mailing Address - Country:US
Mailing Address - Phone:940-300-3054
Mailing Address - Fax:833-905-2567
Practice Address - Street 1:3504 CORINTH PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-1316
Practice Address - Country:US
Practice Address - Phone:940-268-3839
Practice Address - Fax:833-905-2567
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1811213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612962Medicare PIN