Healthcare Provider Details

I. General information

NPI: 1336493790
Provider Name (Legal Business Name): LESLIE L ALLEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 9TH ST STE 260
LUBBOCK TX
79415-5305
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-8185
  • Fax: 806-792-9180
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-785-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP122731
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number775802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: