Healthcare Provider Details

I. General information

NPI: 1851090146
Provider Name (Legal Business Name): LESLIE NICHOLE WOMACK-YOUNG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W MAIN ST
WATERTOWN NY
13601-1381
US

IV. Provider business mailing address

1051 KEOLU DR STE 107
KAILUA HI
96734-3800
US

V. Phone/Fax

Practice location:
  • Phone: 888-585-8882
  • Fax:
Mailing address:
  • Phone: 808-263-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number833262-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-4703
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: