Provider Demographics
NPI:1427056019
Name:MCMINN, LESLIE M (RN, MSN, CFNP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:M
Last Name:MCMINN
Suffix:
Gender:F
Credentials:RN, MSN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 WESTWAY TRL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6254
Mailing Address - Country:US
Mailing Address - Phone:806-354-0348
Mailing Address - Fax:
Practice Address - Street 1:1501 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4307
Practice Address - Country:US
Practice Address - Phone:806-372-8731
Practice Address - Fax:806-372-8746
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538080363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS84958Medicare UPIN
TX8C8965Medicare ID - Type Unspecified