Provider Demographics
NPI:1588091326
Name:IRBY, LESLIE WILHITE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:WILHITE
Last Name:IRBY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ANNE
Other - Last Name:WILHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:888 TARA BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7818
Mailing Address - Country:US
Mailing Address - Phone:225-273-5995
Mailing Address - Fax:225-273-7475
Practice Address - Street 1:888 TARA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7818
Practice Address - Country:US
Practice Address - Phone:225-273-5995
Practice Address - Fax:225-273-7475
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08761363LP0200X
LARN151639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse