Individual
LESLIE TABB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
803 1ST ST, CLEVELAND, MS 38732-2309
(662) 843-2721
Mailing address
803 1ST ST, CLEVELAND, MS 38732-2309
(662) 843-2721
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R855837
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121836
—
MS
01
—
500011524
MEDICARE RAILROAD
MS
Enumeration date
03/16/2006
Last updated
11/21/2016
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