Provider Demographics
NPI:1548786213
Name:CHAMBERS, LESLIE SUE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SUE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:SUE
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1103 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3108
Mailing Address - Country:US
Mailing Address - Phone:228-875-3097
Mailing Address - Fax:
Practice Address - Street 1:1103 HANLEY RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3108
Practice Address - Country:US
Practice Address - Phone:228-875-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011633363LA2100X
MS905747363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care