Provider Demographics
NPI:1598289795
Name:HARVEY, LESLIE BOONE (CRNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BOONE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7345
Mailing Address - Country:US
Mailing Address - Phone:205-292-3182
Mailing Address - Fax:
Practice Address - Street 1:1805 STATION DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5667
Practice Address - Country:US
Practice Address - Phone:334-730-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily