Provider Demographics
NPI:1912237769
Name:MCKENNA, LESLIE BROOK (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BROOK
Last Name:MCKENNA
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 BERGEN PEAK DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2200
Mailing Address - Country:US
Mailing Address - Phone:303-674-6400
Mailing Address - Fax:303-579-3454
Practice Address - Street 1:3081 BERGEN PEAK DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2200
Practice Address - Country:US
Practice Address - Phone:303-674-6400
Practice Address - Fax:303-679-3454
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34639363LF0000X
CO4293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAAA2667Medicare PIN
COAAA2742Medicare PIN