Angelique Marie Leist

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3012004 Issued in KY

Practice address

3103 Breckenridge LN Ste 1
Louisville, KY 40220

Phone

(501) 495-5055

Fax

(502) 495-5057

NPI assigned

Jan 10, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brock Medical, LLCGroup PAC ID 9830354638, 93 clinicians

Fast Pace Kentucky, PLLCGroup PAC ID 0143525998, 213 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brock Medical, LLC

  dba First Care Clinics, LLC

  • Nurse Practitioner
  • London, KY
  • NPI 1023379815
  Medicare reassignment Care Compare group NPD
• Fast Pace Kentucky PLLC

  dba Fast Pace Urgent Care

  • Family Nurse Practitioner
  • Franklin, KY
  • NPI 1457716706
  Medicare reassignment Care Compare group NPD
• Gim of Kentucky PLLC

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1326411026

  Family

  Medicare reassignment NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498

  KY

  Medicare reassignment NPD
• Fast Pace Kentucky PLLC

  dba Fast Pace Health

  • Rural Health Clinic/Center
  • Corbin, KY
  • NPI 1669256913
  NPD
• Fast Pace Kentucky, PLLC

  dba Fast Pace Health

  • Rural Health Clinic/Center
  • Spindale, NC
  • NPI 1942027891
  NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Ocoee, FL
  • NPI 1326906843
  NPD
• Fast Pace Kentucky, PLLC

  • Rural Health Clinic/Center
  • Bardstown, KY
  • NPI 1184381444
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1053828145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 BRECKENRIDGE LN STE 1",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402202798",
            "telephone_number": "501-495-5055",
            "fax_number": "502-495-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 BRECKENRIDGE LN STE 1",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40220",
            "telephone_number": "501-495-5055",
            "fax_number": "502-495-5057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1265 Goss Ave",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402172271",
            "country_code": "US",
            "telephone_number": "502-873-1260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEIST",
        "first_name": "ANGELIQUE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-10",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3012004",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1146850",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rehabinst1@att.net",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3103 Breckenridge Ln Ste 1",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402202798",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "5052590165",
            "affiliation": "Y",
            "endpointDescription": "Fax",
            "affiliationName": "SHC Medical Partners of Kentucky, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2529 Six Mile Ln",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "40220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aleist@shcmedicalpartners.com",
            "affiliation": "Y",
            "endpointDescription": "Work Email",
            "affiliationName": "SHC Medical Partners of Kentucky, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2529 Six Mile Ln",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "40220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angela L Leinenbach Flint, DNP
• Megan Leininger, PHARMD
• Albert E Leis, M.D.
• Alexandra B Leis, NP-C
• Brock Leisge, PHARMD
• Rebecca Leite, APRN
• Tyler D Leiva
• David Isala Leksrisawat, OTR/L
• Leliah Home Health
• Lem Enterprises, LLC (BestCPAPprice.com)

• Family Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.