Provider Demographics
NPI:1386536407
Name:RAGGETT, LESLIE MICHELLE (DNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELLE
Last Name:RAGGETT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MICHELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5947 BRICE CV N
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3529
Mailing Address - Country:US
Mailing Address - Phone:901-288-3282
Mailing Address - Fax:
Practice Address - Street 1:7111 SOUTHCREST PKWY STE 109
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4852
Practice Address - Country:US
Practice Address - Phone:662-349-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily