Provider Demographics
NPI:1629552815
Name:KENT, LEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:KENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:84 SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1812
Mailing Address - Country:US
Mailing Address - Phone:805-591-4727
Mailing Address - Fax:805-439-3394
Practice Address - Street 1:84 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1812
Practice Address - Country:US
Practice Address - Phone:805-591-4727
Practice Address - Fax:805-439-3394
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant