Healthcare Provider Details

I. General information

NPI: 1861605560
Provider Name (Legal Business Name): LESLIE R VILLARRUBIA DNP, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 COUNCIL CIR
TUPELO MS
38801-4938
US

IV. Provider business mailing address

PO BOX 4087
TUPELO MS
38803-4087
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-2500
  • Fax: 662-377-2069
Mailing address:
  • Phone: 662-844-8414
  • Fax: 662-844-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR857919
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: