Healthcare Provider Details

I. General information

NPI: 1720763816
Provider Name (Legal Business Name): LESLIE JEFFRIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 DAVIS BEND RD
CANMER KY
42722-9404
US

IV. Provider business mailing address

2315 DAVIS BEND RD
CANMER KY
42722-9404
US

V. Phone/Fax

Practice location:
  • Phone: 270-528-2333
  • Fax:
Mailing address:
  • Phone: 270-528-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1085999
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: