Provider Demographics
NPI:1699187005
Name:NELSON, LEEANN ANSICA (MD)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:ANSICA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 N STEMMONS FWY STE 200S
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3821
Mailing Address - Country:US
Mailing Address - Phone:214-424-5600
Mailing Address - Fax:
Practice Address - Street 1:8585 N STEMMONS FWY STE 200S
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3821
Practice Address - Country:US
Practice Address - Phone:214-424-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.36842MD207R00000X
TXR6058207RH0002X
FLME136488207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC368426Medicaid
SC368426Medicaid
SCSC9473F694Medicare PIN