NPI 1235583246 · live from the CMS NPI Registry
Leslie Marvene Gallon
Nurse Practitioner, Pediatrics in Fort Campbell, KY. National Provider Identifier 1235583246, active.
NPI record
| NPI | 1235583246 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 650 Joel Dr, Fort Campbell, KY 42223 |
| Practice phone | 270-461-2868 |
| Enumerated | April 15, 2016 |
| Last updated | September 8, 2020 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 2016000618 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.