Provider Demographics
NPI:1871159707
Name:WILLIAMS, LESLIE DAWN (FNP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0360
Mailing Address - Country:US
Mailing Address - Phone:888-339-6065
Mailing Address - Fax:855-308-2340
Practice Address - Street 1:4740 COMMERCIAL PARK CT
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9387
Practice Address - Country:US
Practice Address - Phone:336-245-9521
Practice Address - Fax:855-308-2340
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011781363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871159707Medicaid
NC330765OtherMEDCOST
NCCS2424900282OtherCARESOURCE
NCNN8112AOtherMEDICARE