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NPI Code Detail

MEDICARE: LESLIE MARIE WILSON PNP

MEDICARE: LESLIE MARIE WILSON PNP
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
1363LP2300XPrimary Care Nurse PractitionerAP135215TX
2363LP0200XPediatric Nurse Practitioner708360TX

General Provider Information

NPI Number : 1255854121
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE MARIE WILSON PNP
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-6483
Fax Number : 682-885-3113
Provider Business Practice Location Address
First Line : 1500 COOPER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2710
Country : US
Telephone Number : 682-885-6299
Fax Number : 682-885-1090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2017
Last Update Date : 05/06/2026

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