MEDICARE: LESLY C HERNANDEZ

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1437883238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLY C HERNANDEZ

Provider Business Mailing Address
First Line	:	1536 N BOSTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4102
Country	:	US
Telephone Number	:	918-902-2721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 N BOSTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4102
Country	:	US
Telephone Number	:	918-902-2721
Fax Number	:

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

Provider Enumeration Date	:	07/15/2022
Last Update Date	:	07/15/2022

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Directions to “ LESLY C HERNANDEZ ” Practice Location

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