Active NPI
Leslie Larae Jefferson, CNS, LDN
- Nutritionist
- Bowie, MD
National Provider Identifier
1225429822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- DX3760
- Practice address
- 6113 Gothic LN
Bowie, MD 20720-5304 - Phone
- (301) 221-5571
- NPI assigned
- Feb 18, 2015
- Last updated
- Feb 18, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | DX3760 | MD | Primary |
Addresses
Primary practice location
6113 Gothic LN
Bowie, MD 20720-5304
Mailing address
6113 Gothic LN
Bowie, MD 20720-5304
Phone (301) 221-5571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DX3760 | MD | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424217600000",
"number": "1225429822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6113 GOTHIC LN",
"city": "BOWIE",
"state": "MD",
"postal_code": "207205304",
"telephone_number": "301-221-5571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6113 GOTHIC LN",
"city": "BOWIE",
"state": "MD",
"postal_code": "207205304",
"telephone_number": "301-221-5571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERSON",
"first_name": "LESLIE",
"middle_name": "LARAE",
"name_prefix": "Ms.",
"credential": "CNS, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-18",
"last_updated": "2015-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MD",
"license": "DX3760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.