Healthcare Provider Details

I. General information

NPI: 1801066808
Provider Name (Legal Business Name): JEAN M LESLIE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N CHESTNUT ST
HARRISON AR
72601-4453
US

IV. Provider business mailing address

306 N CHESTNUT ST
HARRISON AR
72601-4453
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8559
  • Fax: 870-741-8423
Mailing address:
  • Phone: 870-741-8559
  • Fax: 870-741-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03155ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: