Healthcare Provider Details

I. General information

NPI: 1083952188
Provider Name (Legal Business Name): LESLIE DEATON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 07/06/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN STE 100
HAZARD KY
41701-9524
US

IV. Provider business mailing address

4055 VALLEY VIEW LN STE 700
DALLAS TX
75244-5045
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1300
  • Fax: 606-439-1400
Mailing address:
  • Phone: 855-984-5121
  • Fax: 606-436-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007850
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: