Provider Demographics
NPI:1003405838
Name:DEJARNETTE, LESLEY ANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:ANNE
Last Name:DEJARNETTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13198 JAMES MADISON HWY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-2808
Mailing Address - Country:US
Mailing Address - Phone:540-672-3010
Mailing Address - Fax:
Practice Address - Street 1:2503 S SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-2690
Practice Address - Country:US
Practice Address - Phone:540-672-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-007504363A00000X
VA0110007504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant