Healthcare Provider Details

I. General information

NPI: 1235866039
Provider Name (Legal Business Name): LESLIE M BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 11/13/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E REED ST
HAYTI MO
63851-1242
US

IV. Provider business mailing address

907 E REED ST
HAYTI MO
63851-1242
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-3230
  • Fax:
Mailing address:
  • Phone: 573-359-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022037471
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221428
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: