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NPI Code Detail

MEDICARE: MRS. LESLIE MARIE HEISER FNP-BC

MEDICARE: MRS. LESLIE MARIE HEISER FNP-BC
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
1163W00000XRegistered NurseRN159964TN
2363L00000XNurse Practitioner159964TN
3363LF0000XFamily Nurse PractitionerAPN17718TN

General Provider Information

NPI Number : 1124450648
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESLIE MARIE HEISER FNP-BC
Provider Business Mailing Address
First Line : 7331 TAZEWELL PIKE
Second Line :
City : CORRYTON
State : TN
Zip : 37721-3516
Country : US
Telephone Number : 865-249-8044
Fax Number :
Provider Business Practice Location Address
First Line : 7331 TAZEWELL PIKE
Second Line :
City : CORRYTON
State : TN
Zip : 37721-3516
Country : US
Telephone Number : 865-249-8044
Fax Number : 865-933-4729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2013
Last Update Date : 05/23/2023

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