Provider Demographics
NPI:1124450648
Name:HEISER, LESLIE MARIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:HEISER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:YARBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7331 TAZEWELL PIKE
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3516
Mailing Address - Country:US
Mailing Address - Phone:865-249-8044
Mailing Address - Fax:
Practice Address - Street 1:7331 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3516
Practice Address - Country:US
Practice Address - Phone:865-249-8044
Practice Address - Fax:865-933-4729
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN159964163W00000X
TN159964363L00000X
TNAPN17718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty