Healthcare Provider Details

I. General information

NPI: 1215041843
Provider Name (Legal Business Name): LESLIE SHARRON LINDSEY FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date: 07/18/2007
Reactivation Date: 03/10/2008

III. Provider practice location address

100 S MCGEE ST
BORGER TX
79007-4020
US

IV. Provider business mailing address

100 S MCGEE ST
BORGER TX
79007-4020
US

V. Phone/Fax

Practice location:
  • Phone: 806-273-5552
  • Fax: 806-274-9619
Mailing address:
  • Phone: 806-273-5552
  • Fax: 806-274-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number233944
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1465952031
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number233944
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44421
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: