MEDICARE: MRS. LESLIE SMITH BAUM APRN, FNP-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
1	363LF0000X	Family Nurse Practitioner	31849	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31849	OTHER	TN	STATE OF TN

General Provider Information

NPI Number	:	1669101309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE SMITH BAUM APRN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1
Second Line	:
City	:	HENNING
State	:	TN
Zip	:	38041-0001
Country	:	US
Telephone Number	:	731-780-8171
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 W UNIVERSITY PKWY STE C
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1667
Country	:	US
Telephone Number	:	731-300-6155
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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