MEDICARE: KATHY LESLIE REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	1031737	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4900016	OTHER	KY	UHC
2	00000067574	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1063598415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY LESLIE REGISTERED NURSE

Provider Business Mailing Address
First Line	:	4714 OAK POINTE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-6438
Country	:	US
Telephone Number	:	502-339-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 OAK POINTE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-6438
Country	:	US
Telephone Number	:	502-339-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	07/08/2007

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