Provider Demographics
NPI:1154990109
Name:BRADY, LESLEE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:MARIE
Last Name:BRADY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 N 110TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-3603
Mailing Address - Country:US
Mailing Address - Phone:773-332-7116
Mailing Address - Fax:
Practice Address - Street 1:2600 WESTHALL LN
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7102
Practice Address - Country:US
Practice Address - Phone:407-200-2273
Practice Address - Fax:407-200-1353
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80347-121363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner