Leslie Lewynell Provost

Primary specialty

Occupational Health Nurse PractitionerTaxonomy code 363LX0106X

License

200771 Issued in LA

Practice address

510 E Stoner Ave
Shreveport, LA 71101-4243

Phone

(318) 221-8411

NPI assigned

Apr 19, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1700449220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 REEDS REEF",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711129757",
            "telephone_number": "318-550-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E STONER AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014243",
            "telephone_number": "318-221-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "LESLIE",
        "middle_name": "LEWYNELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-19",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "LA",
            "license": "200771",
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "LA",
            "license": "200771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proprium Solutions LLC
• Kaitlin Prosinski, MOT, OTR/L
• John M Provenza, M.D.
• Stephanie Maria Provenzano
• Provider Care Inc.
• Elizabeth Pruitt, M.ED
• Evelyn Baranco Pryor, MD
• Jeremy Edwin Pryor
• Psychiatric Nurse Practitioners
• Psychology Associates of N.W. Louisiana, L.L.C. (Goebel, Vigen, & Associates)

• Occupational Health Nurse Practitioner in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Occupational Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.