Healthcare Provider Details

I. General information

NPI: 1447891569
Provider Name (Legal Business Name): LESLIE LARTEY PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTHRIDGE PKWY STE 307A
CULPEPER VA
22701-3775
US

IV. Provider business mailing address

700 SOUTHRIDGE PKWY STE 307A
CULPEPER VA
22701-3775
US

V. Phone/Fax

Practice location:
  • Phone: 540-868-5979
  • Fax: 434-214-9064
Mailing address:
  • Phone: 540-868-5979
  • Fax: 434-939-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178397
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178397
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: