Provider Demographics
NPI:1255322590
Name:TSCHOEPE-WHITE, LEAHGAIL (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAHGAIL
Middle Name:
Last Name:TSCHOEPE-WHITE
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 1:277 BUDDY GANEM DR STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3202
Mailing Address - Country:US
Mailing Address - Phone:361-777-3900
Mailing Address - Fax:361-413-0274
Practice Address - Street 1:9139 WESTOVER HILLS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2885
Practice Address - Country:US
Practice Address - Phone:210-437-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180747101Medicaid
TX8D8925Medicare PIN
TXS85996Medicare UPIN