Provider Demographics
NPI:1386015931
Name:FOSHIE, LESLIE W (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:W
Last Name:FOSHIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4039
Mailing Address - Country:US
Mailing Address - Phone:423-525-5462
Mailing Address - Fax:423-525-5232
Practice Address - Street 1:1140 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4039
Practice Address - Country:US
Practice Address - Phone:423-525-5462
Practice Address - Fax:423-525-5232
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1386015931OtherALL OTHER ISSUERS
TN1386015931Medicaid