Healthcare Provider Details

I. General information

NPI: 1124450648
Provider Name (Legal Business Name): LESLIE MARIE HEISER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE MARIE YARBERRY

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 TAZEWELL PIKE
CORRYTON TN
37721-3516
US

IV. Provider business mailing address

7331 TAZEWELL PIKE
CORRYTON TN
37721-3516
US

V. Phone/Fax

Practice location:
  • Phone: 865-249-8044
  • Fax: 865-933-4729
Mailing address:
  • Phone: 865-249-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN159964
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number159964
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN17718
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: