Provider Demographics
NPI:1336473826
Name:LEACH, DEANNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
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 1:134 INDUSTRIAL PARK RD
Mailing Address - Street 2:P. O. BOX 880
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-9785
Mailing Address - Country:US
Mailing Address - Phone:304-884-7880
Mailing Address - Fax:304-884-8902
Practice Address - Street 1:134 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-9785
Practice Address - Country:US
Practice Address - Phone:304-884-7880
Practice Address - Fax:304-884-8902
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01464363A00000X
WV477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant