Provider Demographics
NPI:1316443484
Name:LESA G ANSELL
Entity type:Organization
Organization Name:LESA G ANSELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, AGNP-C, DC
Authorized Official - Phone:972-291-1992
Mailing Address - Street 1:6080 S HULEN ST
Mailing Address - Street 2:STE 360 PMB 232
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4810
Mailing Address - Country:US
Mailing Address - Phone:214-732-8805
Mailing Address - Fax:817-977-8981
Practice Address - Street 1:214 W BELT LINE RD STE A
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1105
Practice Address - Country:US
Practice Address - Phone:972-291-1992
Practice Address - Fax:972-637-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LA2200X
TXAP131295363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty