Provider Demographics
NPI:1699176800
Name:PELL, LESLIE MICHELL (NPRNCNP, APRN,PMHN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELL
Last Name:PELL
Suffix:
Gender:F
Credentials:NPRNCNP, APRN,PMHN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MICHELLE
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG, 5TH FL
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-4121
Mailing Address - Fax:317-880-0343
Practice Address - Street 1:3171 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4784
Practice Address - Country:US
Practice Address - Phone:317-941-5003
Practice Address - Fax:317-931-5140
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2021-11-12
Deactivation Date:2019-02-22
Deactivation Code:
Reactivation Date:2019-03-18
Provider Licenses
StateLicense IDTaxonomies
OHRN.458718163W00000X
IN71005112B363LP0808X
OHAPRN.CNP.024210363LP0808X
IN71005112A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse