Provider Demographics
NPI:1174799704
Name:SKINNER, LESLIE KATRINA (M D)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:KATRINA
Last Name:SKINNER
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19087B GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3899
Mailing Address - Country:US
Mailing Address - Phone:251-928-5568
Mailing Address - Fax:251-928-2605
Practice Address - Street 1:19087-B GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3899
Practice Address - Country:US
Practice Address - Phone:251-928-5568
Practice Address - Fax:251-928-2605
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD28869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL111179Medicaid