Healthcare Provider Details

I. General information

NPI: 1538375191
Provider Name (Legal Business Name): LESLEY EVAN WARD P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 N 2ND ST
MEMPHIS TN
38105-1632
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1956
  • Fax: 901-448-9696
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1416
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: