Healthcare Provider Details

I. General information

NPI: 1497017404
Provider Name (Legal Business Name): LESLEE MICHELE LOWE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLEE MICHELE DAVENPORT RN

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MORGAN ST SUITE 8
PARAGOULD AR
72450-3949
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD
JONESBORO AR
72401-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-335-9483
  • Fax: 870-335-9487
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA004153
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: