Provider Demographics
NPI:1346431178
Name:MORRIS, LESLIE ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ROOKER
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4545 HERITAGE TRACE PKWY STE 1515
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8921
Mailing Address - Country:US
Mailing Address - Phone:817-337-6604
Mailing Address - Fax:807-337-6866
Practice Address - Street 1:4545 HERITAGE TRACE PKWY STE 1515
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-337-6604
Practice Address - Fax:807-337-6866
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00611363A00000X, 1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB133364Medicare PIN
TXTXB120789Medicare PIN
TXTXB120789Medicare PIN