Basic Information
Provider Information
NPI: 1386015931
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOSHIE
FirstName: LESLIE
MiddleName: W
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1225 E WEISGARBER RD
Address2: SUITE 200
City: KNOXVILLE
State: TN
PostalCode: 379092604
CountryCode: US
TelephoneNumber: 8655844747
FaxNumber: 8655841363
Practice Location
Address1: 555 JUSTIS DR
Address2:  
City: GREENEVILLE
State: TN
PostalCode: 377454288
CountryCode: US
TelephoneNumber: 4237837965
FaxNumber: 4237837970
Other Information
ProviderEnumerationDate: 10/08/2015
LastUpdateDate: 04/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X20322TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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