Provider Demographics
NPI:1083375778
Name:LEE, LEEANNA BEASLEY (PA)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:BEASLEY
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 MAPLE GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-7692
Mailing Address - Country:US
Mailing Address - Phone:910-567-6194
Mailing Address - Fax:
Practice Address - Street 1:1480 MAPLE GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7692
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant