MEDICARE: LESLIE MARIE HINTON ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	626289	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8N3514	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1477551414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MARIE HINTON ANP

Provider Business Mailing Address
First Line	:	2700 CITIZENS PLAZA
Second Line	:	SUITE 203
City	:	VICTORIA
State	:	TX
Zip	:	77901-5754
Country	:	US
Telephone Number	:	361-574-1517
Fax Number	:	361-574-1518

Provider Business Practice Location Address
First Line	:	2700 CITIZENS PLZ
Second Line	:	SUITE 203
City	:	VICTORIA
State	:	TX
Zip	:	77901-5754
Country	:	US
Telephone Number	:	361-574-1517
Fax Number	:	361-574-1518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/24/2009

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