Provider Demographics
NPI:1366616351
Name:HYATT, LESLIE GILMORE (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:GILMORE
Last Name:HYATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:704-384-1226
Practice Address - Street 1:108 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1218
Practice Address - Country:US
Practice Address - Phone:336-481-8655
Practice Address - Fax:336-277-9165
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003948363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily