Provider Demographics
NPI:1801051610
Name:BYRNE, LESLIE (NP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:BYRNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:BUBON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7618 TRAPPERS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7421
Mailing Address - Country:US
Mailing Address - Phone:910-339-8617
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER ROAD
Practice Address - Street 2:PO DRAWER B - HWY 421
Practice Address - City:MAMERS
Practice Address - State:NC
Practice Address - Zip Code:27552
Practice Address - Country:US
Practice Address - Phone:910-893-5402
Practice Address - Fax:910-893-2567
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily