Provider Demographics
NPI:1497032544
Name:MCMORRIS, LEAH (PA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MCMORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 FLANDERS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9168
Mailing Address - Country:US
Mailing Address - Phone:225-769-5554
Mailing Address - Fax:225-761-3334
Practice Address - Street 1:4845 MAIN ST
Practice Address - Street 2:SUITE B1
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3943
Practice Address - Country:US
Practice Address - Phone:225-761-5597
Practice Address - Fax:225-761-5270
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200468363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00958218Medicaid
LA2336223Medicaid
LA984896169OtherTID
LA984896169OtherTID