Individual
LESLIE LEWYNELL PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
715 REEDS REEF, BOSSIER CITY, LA 71112-9757
(318) 550-7495
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
200771
LA
363LX0106X
Occupational Health Nurse Practitioner
Primary
200771
LA
Other
Enumeration date
04/19/2019
Last updated
09/01/2023
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