Basic Information
| Provider Information | |||||||||
| NPI: | 1831333871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINCENT | ||||||||
| FirstName: | LESLEY | ||||||||
| MiddleName: | ROBINSON | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 DUNN ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703604413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858725864 | ||||||||
| FaxNumber: | 9858720317 | ||||||||
| Practice Location | |||||||||
| Address1: | 4909 GREAT RIVER DRIVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012828980 | ||||||||
| FaxNumber: | 6016936561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2009 | ||||||||
| LastUpdateDate: | 06/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R868254 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 01139881 | 05 | MS | MEDICAID | 731-05568 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER |