Provider Demographics
NPI:1497146518
Name:GREY, LESLIE CARYN (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CARYN
Last Name:GREY
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:CARYN
Other - Last Name:NOONAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PA-C
Mailing Address - Street 1:43 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841-1006
Mailing Address - Country:US
Mailing Address - Phone:888-628-9633
Mailing Address - Fax:
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1006
Practice Address - Country:US
Practice Address - Phone:888-628-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00875363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400329269OtherMEDICARE NGS