Provider Demographics
NPI:1447640669
Name:ROSS, LESLIE (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SW BIG BEND TRL
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4449
Mailing Address - Country:US
Mailing Address - Phone:254-897-3444
Mailing Address - Fax:254-897-9973
Practice Address - Street 1:507 SW BIG BEND TRL
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4449
Practice Address - Country:US
Practice Address - Phone:254-897-3444
Practice Address - Fax:254-897-9973
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP127305OtherNURSE PRACTITIONER LICENSE
TXMR3484867OtherDEA