Provider Demographics
NPI:1184103921
Name:SMITH, LESLIE MUSE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MUSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26419 FOREST PINE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8373
Mailing Address - Country:US
Mailing Address - Phone:318-348-7683
Mailing Address - Fax:
Practice Address - Street 1:1011 HIGHWAY 6 S STE 311
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1040
Practice Address - Country:US
Practice Address - Phone:713-575-2000
Practice Address - Fax:713-575-2031
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931246163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management