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NPI Code Detail

MEDICARE: MRS. LESLIE LEWIS BARRY NP-C

MEDICARE: MRS. LESLIE LEWIS BARRY NP-C
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
1363L00000XNurse PractitionerR875421MS

General Provider Information

NPI Number : 1609178532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESLIE LEWIS BARRY NP-C
Provider Business Mailing Address
First Line : 970 LAKELAND DR STE 61
Second Line :
City : JACKSON
State : MS
Zip : 39216-4682
Country : US
Telephone Number : 601-982-7850
Fax Number :
Provider Business Practice Location Address
First Line : 970 LAKELAND DR STE 61
Second Line :
City : JACKSON
State : MS
Zip : 39216-4682
Country : US
Telephone Number : 601-982-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2010
Last Update Date : 01/11/2021

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