Provider Demographics
NPI:1033194436
Name:ARCHER, LESLIE KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KAY
Last Name:ARCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 THREE DEGREE RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053-1221
Mailing Address - Country:US
Mailing Address - Phone:814-592-9143
Mailing Address - Fax:
Practice Address - Street 1:1158 PITTSBURGH RD STE 101
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059-3128
Practice Address - Country:US
Practice Address - Phone:833-604-7215
Practice Address - Fax:724-287-4128
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002688L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical