Provider Demographics
NPI:1316468747
Name:WALKER, LESLEE MOSS (LICENSED ACUPUNCTURE)
Entity type:Individual
Prefix:MS
First Name:LESLEE
Middle Name:MOSS
Last Name:WALKER
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10268 BEE CAMP COURT
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055
Mailing Address - Country:US
Mailing Address - Phone:360-606-9480
Mailing Address - Fax:
Practice Address - Street 1:6155 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1957
Practice Address - Country:US
Practice Address - Phone:317-379-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist