Basic Information
Provider Information
NPI: 1326500760
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARNOLD
FirstName: LESLIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14100 SAN PEDRO AVE STE 412
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782322009
CountryCode: US
TelephoneNumber: 2102818669
FaxNumber: 2103145044
Practice Location
Address1: 4522 FREDERICKSBURG RD STE A11
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782016509
CountryCode: US
TelephoneNumber: 2109984780
FaxNumber: 2103145044
Other Information
ProviderEnumerationDate: 04/04/2019
LastUpdateDate: 09/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP140537TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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