Basic Information
| Provider Information | |||||||||
| NPI: | 1427200823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUNT | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA - C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721436964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134208195 | ||||||||
| FaxNumber: | 5134208824 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 S BREIEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450446703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134208195 | ||||||||
| FaxNumber: | 5134208824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA-341 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.