Individual
LESLIE ANN HAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-4749
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APN000005817
TN
363L00000X
Nurse Practitioner
Primary
R888820
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
568
CERTIFICATE OF FITTNESS
TN
01
—
APN000005817
APN LICENSE
TN
01
—
RN0000061509
RN LICENSE
TN
Enumeration date
09/15/2006
Last updated
02/26/2019
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