Active NPI
Leslie Nain Bautista
- Psychologist
- College Station, TX
National Provider Identifier
1366056277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 39688
- Practice address
- 410 Tarrow St Ste 102
College Station, TX 77840-7892 - Phone
- (979) 721-6062
- NPI assigned
- Sep 8, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 39688 | TX | Primary |
Addresses
Primary practice location
410 Tarrow St Ste 102
College Station, TX 77840-7892
Mailing address
410 Tarrow St Ste 102
College Station, TX 77840-7892
Phone (979) 721-6062
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39688 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672358400000",
"number": "1366056277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 TARROW ST STE 102",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778407892",
"telephone_number": "979-721-6062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 TARROW ST STE 102",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778407892",
"telephone_number": "979-721-6062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "LESLIE",
"middle_name": "NAIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-08",
"last_updated": "2022-12-30",
"certification_date": "2022-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "39688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.