Healthcare Provider Details

I. General information

NPI: 1144999574
Provider Name (Legal Business Name): LESLIE BRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE RICKETTS

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2749
US

IV. Provider business mailing address

281 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2749
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0850
  • Fax: 423-698-0511
Mailing address:
  • Phone: 423-698-0850
  • Fax: 833-450-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30258
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: