Van Dyke, Leslie Polk

Van Dyke, Leslie Polk is an individual health care provider with primary practice located at 1658 W Grande Blvd Ste 100, Tyler TX 75703-4426. She recently has only one registered license in Nursing Service Providers / Registered Nurse, which is considered as her primary health care specialty. Van Dyke, Leslie Polk can be contacted via phone (903) 617-6239.

Contact Information

Primary practice address
1658 W Grande Blvd Ste 100 Tyler TX 75703-4426
Phone: (903) 617-6239
Fax: (903) 617-6249
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 53-45551-051 Kansas

Profile Details

NPI number 1124023916
LBN Legal business name Van Dyke, Leslie Polk
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated May 7th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124023916 NPPES
Texas Other 8772NA BCBS
Texas MEDICAID 200253540A BCBS

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