Healthcare Provider Details

I. General information

NPI: 1194269464
Provider Name (Legal Business Name): LESLYE C BRANSFORD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 JOHNSON BLVD
MURRAY KY
42071-2925
US

IV. Provider business mailing address

471 LAKEVIEW DR
MAYFIELD KY
42066-4764
US

V. Phone/Fax

Practice location:
  • Phone: 270-917-1401
  • Fax: 270-957-8811
Mailing address:
  • Phone: 270-559-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010922
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: