Provider Demographics
NPI:1235104589
Name:LEACH, DENISE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:A
Last Name:LEACH
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:304-335-6158
Practice Address - Street 1:ROUTE 219/250
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-0247
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:304-335-6158
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00415363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3001225OtherBRICKSTREET WORKERS COMP
P00670309OtherRAILROAD MEDICARE PTAN
WV1023728OtherNCCPA
WV3810005319Medicaid
WV30543OtherWV RN LICENSE
WVFQ415OtherHEALTH PLAN PROVIDER
WV001804180OtherMTN STATE BC/BS SERVICE
WV001804181OtherMTN STATE BC/BS PAY TO 1
WV328667OtherCARELINK
WV001967359OtherMTN STATE BC/BS PAY TO 2
WV001967359OtherMTN STATE BC/BS PAY TO 2
WV1023728OtherNCCPA
WVLE2027661Medicare PIN
WV328667OtherCARELINK