NPIMap

Individual provider Active NPI

Leslie Nelson, FNP

  • Family Nurse Practitioner
  • Canon City, CO
National Provider Identifier
1720721251
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0997494-NP Issued in CO
Practice address
730 Macon Ave
Canon City, CO 81212-3314
Phone
(719) 275-1618
NPI assigned
Apr 13, 2022
Last updated
Oct 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0997494-NP CO Primary

Addresses

Primary practice location

730 Macon Ave
Canon City, CO 81212-3314

Mailing address

844 S 5TH St
Canon City, CO 81212-4121
Phone (710) 285-5019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220716000042 CO Practitioner - Nurse Practitioner 2264813658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canon Professional Wellness Clinic LLCGroup PAC ID 1456708890, 3 clinicians

Practice addresses (Care Compare)

730 Macon Ave
Canon City, CO 81212-3314
Phone (719) 275-1618

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Canon Professional Wellness Clinic LLC Family CurrentSince Sep 27, 2023 Accepting new patients

Locations

730 Macon Ave
Canon City, CO 81212
Phone (719) 275-1618

Interoperability endpoints

  • Direct secure messaging: leslie.nelson.1@19898.direct.athenahealth.com

Organizations & group practices 1

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

Hospital & facility affiliations 25

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1720721251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "844 S 5TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124121",
            "telephone_number": "710-285-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 MACON AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123314",
            "telephone_number": "719-275-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "LESLIE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0997494-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.