Individual
DR. SHANNA MOORE LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
225 MEDICAL CENTER DR STE 101, PADUCAH, KY 42003-7934
(270) 441-4357
Mailing address
225 MEDICAL CENTER DR STE 101, PADUCAH, KY 42003-7934
(270) 441-4357
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41554
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100041410
—
KY
01
—
K247560
MEDICARE PTAN
KY
Enumeration date
10/12/2006
Last updated
01/09/2024
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