Healthcare Provider Details

I. General information

NPI: 1992191159
Provider Name (Legal Business Name): LESLIE ANN ACOSTA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN ACOSTA NP

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W MAIN ST
FRANKFORT KY
40601-1815
US

IV. Provider business mailing address

PO BOX 1595
MIDDLETOWN CT
06457-8095
US

V. Phone/Fax

Practice location:
  • Phone: 860-788-6404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN99733-NP-C
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009365
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261767
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1143597
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: