Healthcare Provider Details

I. General information

NPI: 1184915340
Provider Name (Legal Business Name): MRS. ASHLEY LESCANEC TALBOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ASHLEY PAIGE LESCANEC

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-1009
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-1009
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-5222
  • Fax: 336-716-6415
Mailing address:
  • Phone: 336-716-5222
  • Fax: 336-716-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2013-01662
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2013-01662
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: