Basic Information
| Provider Information | |||||||||
| NPI: | 1063643849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OXENDINE | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | KENDRA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602458 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102766767 | ||||||||
| FaxNumber: | 9102767877 | ||||||||
| Practice Location | |||||||||
| Address1: | 700A PROGRESS PL | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283525545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102766767 | ||||||||
| FaxNumber: | 9102767877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 11/11/2014 | ||||||||
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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 | 5004421 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 189147 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1063643849 | 05 | NC | MEDICAID | 5004421 | 01 | NC | NC BOARD OF NURSING | OTHER | NP2675 | 05 | SC | MEDICAID | 7005113 | 05 | NC | MEDICAID |