Healthcare Provider Details

I. General information

NPI: 1114389319
Provider Name (Legal Business Name): LESHAY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 COLONIAL DR
BATON ROUGE LA
70806
US

IV. Provider business mailing address

411 COLONIAL DR
BATON ROUGE LA
70806-6506
US

V. Phone/Fax

Practice location:
  • Phone: 252-926-9706
  • Fax:
Mailing address:
  • Phone: 225-926-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: