Provider Demographics
NPI:1265635981
Name:GRIFFIN, LEANNE STEGALL (RD, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:STEGALL
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 HARKRIDER ST STE B
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4471
Mailing Address - Country:US
Mailing Address - Phone:501-944-4019
Mailing Address - Fax:
Practice Address - Street 1:1014 HARKRIDER ST STE B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4471
Practice Address - Country:US
Practice Address - Phone:501-944-4019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant