Healthcare Provider Details

I. General information

NPI: 1396998423
Provider Name (Legal Business Name): LESLIE HURST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 PICKWICK ST S
SAVANNAH TN
38372-3519
US

IV. Provider business mailing address

1410 PICKWICK ST S
SAVANNAH TN
38372-3519
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-5054
  • Fax: 731-925-5699
Mailing address:
  • Phone: 731-925-5054
  • Fax: 731-925-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN103294
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: