Provider Demographics
NPI:1427424019
Name:BUCKLEY, LESLIE ANN (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:JEPPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1100 H ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2338
Mailing Address - Country:US
Mailing Address - Phone:209-238-1780
Mailing Address - Fax:
Practice Address - Street 1:1100 H ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2338
Practice Address - Country:US
Practice Address - Phone:209-238-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN345150 NP4466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily