Healthcare Provider Details

I. General information

NPI: 1205448651
Provider Name (Legal Business Name): LESLIE B STELLY APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E RUSSELL AVE
WELSH LA
70591-4844
US

IV. Provider business mailing address

PO BOX 122539 DEPT 2539
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-734-4500
  • Fax: 337-734-4400
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214454
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: