Healthcare Provider Details

I. General information

NPI: 1700718368
Provider Name (Legal Business Name): WEST PLAINS DERMATOLOGY AND SKIN CANCER TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E STATE ROUTE K
WEST PLAINS MO
65775-6616
US

IV. Provider business mailing address

8978 COUNTY ROAD 6470
WEST PLAINS MO
65775-6631
US

V. Phone/Fax

Practice location:
  • Phone: 417-588-0456
  • Fax:
Mailing address:
  • Phone: 417-588-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE ANN MARSHALL
Title or Position: DERMATOLOGIST
Credential: DO
Phone: 417-588-0456