Healthcare Provider Details

I. General information

NPI: 1326735911
Provider Name (Legal Business Name): LESLIE PARDUE APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S RISING SUN DR STE B
NAMPA ID
83686-6000
US

IV. Provider business mailing address

920 S RISING SUN DR STE B
NAMPA ID
83686-6000
US

V. Phone/Fax

Practice location:
  • Phone: 208-248-4687
  • Fax:
Mailing address:
  • Phone: 208-248-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number77437
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number198356
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: