Provider Demographics
NPI:1447579222
Name:PLANTON, LEESA
Entity Type:Individual
Prefix:MRS
First Name:LEESA
Middle Name:
Last Name:PLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GAMECOCK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3398
Mailing Address - Country:US
Mailing Address - Phone:843-769-8215
Mailing Address - Fax:843-769-8216
Practice Address - Street 1:27 GAMECOCK AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3398
Practice Address - Country:US
Practice Address - Phone:843-769-8215
Practice Address - Fax:843-769-8216
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health