MEDICARE: LESLIE BURTON

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	363L00000X	Nurse Practitioner	105868	OK

General Provider Information

NPI Number	:	1699323097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE BURTON

Provider Business Mailing Address
First Line	:	7912 E 31ST CT STE 320
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-1305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7912 E 31ST CT STE 320
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-1305
Country	:	US
Telephone Number	:	918-496-8499
Fax Number	:

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

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	04/12/2023

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Directions to “ LESLIE BURTON ” Practice Location

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