Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Angelique Marie Leist

Individual provider Family Nurse Practitioner · NPI 1053828145

Angelique Marie Leist is a Nurse Practitioner in Louisville, Kentucky. Qualified in 2015, 11 years ago. Practices with Brock Medical, LLC, a 94-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
11
Licensed in
KY
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

3103 Breckenridge Ln Ste 1
Louisville, KY 40220
Phone: (501) 495-5055
Fax: (502) 495-5057
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1265 Goss Ave, Louisville, KY 40217-2271 — (502) 873-1260

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 3012004 (KY)
Registered Nurse Taxonomy 163W00000X · Licence 1146850 (KY)

Record details

NPI number1053828145
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 10, 2018
Last updated in NPPESNovember 27, 2023
Certification dateApril 24, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Brock Medical, Llc — 94 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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