Healthcare Provider Details

I. General information

NPI: 1619490307
Provider Name (Legal Business Name): LESLIE SULLINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 MARKETPLACE BLVD STE 6
JOHNSON CITY TN
37604-2361
US

IV. Provider business mailing address

2004 HAYES ST STE 800
NASHVILLE TN
37203-2659
US

V. Phone/Fax

Practice location:
  • Phone: 423-656-0716
  • Fax: 423-656-0705
Mailing address:
  • Phone: 615-329-0570
  • Fax: 615-329-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23046
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: