Healthcare Provider Details

I. General information

NPI: 1700264637
Provider Name (Legal Business Name): STEPHNIE ANN LEESON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 599
PINON AZ
86510-0599
US

IV. Provider business mailing address

PO BOX 599
PINON AZ
86510-0599
US

V. Phone/Fax

Practice location:
  • Phone: 505-489-0112
  • Fax:
Mailing address:
  • Phone: 505-489-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000019193
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: