Healthcare Provider Details

I. General information

NPI: 1134259815
Provider Name (Legal Business Name): NADIA NICOLE LESLIE ATC,LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. NADIA NICOLE COLE

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THUNDERBIRD CIR ATHLETICS DEPARTMENT
HOBBS NM
88240-0200
US

IV. Provider business mailing address

125 E GREEN ACRES DR
HOBBS NM
88240-4426
US

V. Phone/Fax

Practice location:
  • Phone: 575-492-2745
  • Fax:
Mailing address:
  • Phone: 915-731-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2942
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number533
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: