Provider Demographics
NPI:1508406448
Name:LEYERLE, AMBER LYNN (PA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:LEYERLE
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 1:2535 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2331
Mailing Address - Country:US
Mailing Address - Phone:877-314-8990
Mailing Address - Fax:833-794-3342
Practice Address - Street 1:2535 W OAK ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2331
Practice Address - Country:US
Practice Address - Phone:877-314-8990
Practice Address - Fax:833-794-3342
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT65792255A2300X
363A00000X
TXPA13775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer