Provider Demographics
NPI:1063598415
Name:LESLIE, KATHY (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 OAK POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6438
Mailing Address - Country:US
Mailing Address - Phone:502-339-6363
Mailing Address - Fax:
Practice Address - Street 1:4714 OAK POINTE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6438
Practice Address - Country:US
Practice Address - Phone:502-339-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1031737163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4900016OtherUHC
KY00000067574OtherANTHEM