LESLIE LEWYNELL PROVOST

SHREVEPORT, LA
NPI1700449220
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LX0106X Nurse Practitioner, Occupational Health
(Licence: LA  200771)
Additional Taxonomies363LP2300X Nurse Practitioner, Primary Care
(Licence: LA  200771)
Enumeration Date2019-04-19
Last Update Date2023-09-01
Business Address
LESLIE LEWYNELL PROVOST
510 E STONER AVE
SHREVEPORT, LA 71101-4243
Phone number: 318-221-8411
Mailing Address
LESLIE LEWYNELL PROVOST
715 REEDS REEF
BOSSIER CITY, LA 71112-9757
Phone number: 318-550-7495
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