Provider Demographics
NPI:1043746936
Name:HARRIS, AMANDA LEBLANC (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEBLANC
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 6625
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-6625
Mailing Address - Country:US
Mailing Address - Phone:504-391-5454
Mailing Address - Fax:
Practice Address - Street 1:11295 E TAYLOR RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4197
Practice Address - Country:US
Practice Address - Phone:228-864-3300
Practice Address - Fax:228-864-3333
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant