Basic Information
| Provider Information | |||||||||
| NPI: | 1396369815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | LESLIE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1300 | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712951300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184125265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5745 HIGHWAY 17 | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712955688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187223333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2020 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP.213639 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2528041 | 05 | LA | MEDICAID | P02480309 | 01 | LA | RRMEDICARE | OTHER | 14679527 | 01 | CAQH | OTHER | 1D4182 | 01 | LA | MEDICARE | OTHER |