Provider Demographics
NPI:1598005746
Name:LEGGETT, LINDSAY BANNON (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BANNON
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ELIZABETH
Other - Last Name:BANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1883 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1236
Mailing Address - Country:US
Mailing Address - Phone:808-242-8765
Mailing Address - Fax:
Practice Address - Street 1:1883 MILL ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1236
Practice Address - Country:US
Practice Address - Phone:808-242-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant