Provider Demographics
NPI:1063542553
Name:DUCKETT, LEZLIE (NP-PSYCHIATRY)
Entity type:Individual
Prefix:
First Name:LEZLIE
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:NP-PSYCHIATRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 EVERGREEN LN STE B
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7928
Mailing Address - Country:US
Mailing Address - Phone:928-537-6841
Mailing Address - Fax:928-532-2192
Practice Address - Street 1:2051 EVERGREEN LN STE B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7928
Practice Address - Country:US
Practice Address - Phone:928-537-6841
Practice Address - Fax:928-532-2192
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN130793363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8EB686Medicare PIN
Q44326Medicare UPIN
AZ8EB650Medicare PIN
AZ899859Medicaid
AZ8EB649Medicare PIN
AZ8EB685Medicare PIN
AZ8EB648Medicare PIN