Provider Demographics
NPI:1912417205
Name:LESLIE, CHRISTINE MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 SPRUCE PINE RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-7405
Mailing Address - Country:US
Mailing Address - Phone:407-716-1057
Mailing Address - Fax:
Practice Address - Street 1:1907 W MORRIS BLVD STE A200
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3880
Practice Address - Country:US
Practice Address - Phone:865-673-5000
Practice Address - Fax:865-588-5711
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22661208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034996Medicaid
TNT00969AOtherMEDICARE