Healthcare Provider Details

I. General information

NPI: 1205509726
Provider Name (Legal Business Name): LESLEY AMBER METTS MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S EDGEWOOD DR
KNOX IN
46534-8226
US

IV. Provider business mailing address

16588 S 250 W
HANNA IN
46340-9753
US

V. Phone/Fax

Practice location:
  • Phone: 574-772-6030
  • Fax:
Mailing address:
  • Phone: 219-851-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011428A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: