Healthcare Provider Details

I. General information

NPI: 1346616257
Provider Name (Legal Business Name): LESLEY F SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

PO BOX 123535 3535
DALLAS TX
75312-3535
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4000
  • Fax: 904-265-8181
Mailing address:
  • Phone: 855-686-8430
  • Fax: 904-265-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08419
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: