Provider Demographics
NPI:1528399011
Name:HARCAR, LESLEY ANNE (PAC)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANNE
Last Name:HARCAR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 IRA E WOODS
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-329-2263
Mailing Address - Fax:817-329-3793
Practice Address - Street 1:2321 IRA E WOODS AVE
Practice Address - Street 2:#180
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8632
Practice Address - Country:US
Practice Address - Phone:817-329-2263
Practice Address - Fax:817-329-3793
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1091059OtherNCCPA CERTIF. #
TXPA06575OtherTEXAS STATE LICENSE NUMBER
TX8521NQOtherBCBS PV#