Provider Demographics
NPI:1548554488
Name:ROSS, LESLEY ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANN
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 KANAWHA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1319
Mailing Address - Country:US
Mailing Address - Phone:304-400-4545
Mailing Address - Fax:304-400-4546
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-414-2802
Practice Address - Fax:304-414-2819
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN56155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily