Healthcare Provider Details

I. General information

NPI: 1083082283
Provider Name (Legal Business Name): LESLEE RONALD ADAMS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W STE 211
PROVO UT
84604-3305
US

IV. Provider business mailing address

4019 W 12600 S STE 120
RIVERTON UT
84096-7405
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7327
  • Fax: 801-375-8860
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0175720
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991951-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330534-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: