Healthcare Provider Details

I. General information

NPI: 1639701022
Provider Name (Legal Business Name): ANIKA ELAYNE LESLIE APRN-ACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 BRIAR CREEK RD
LITTLE ROCK AR
72211-2402
US

IV. Provider business mailing address

1108 BRIAR CREEK RD
LITTLE ROCK AR
72211-2402
US

V. Phone/Fax

Practice location:
  • Phone: 501-553-3590
  • Fax: 228-356-4236
Mailing address:
  • Phone: 501-553-3590
  • Fax: 228-356-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number124003
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0136702TELE
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-80978-011
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1108659
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5017307
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024186793
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209029015
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR090467
License Number StateAR
# 9
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: