Provider Demographics
NPI:1659929834
Name:FIELDS BROADBENT, LEIGH STACEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:STACEY
Last Name:FIELDS BROADBENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LEIGH
Other - Middle Name:STACEY
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:401 E ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3242
Mailing Address - Country:US
Mailing Address - Phone:202-698-9021
Mailing Address - Fax:202-698-9103
Practice Address - Street 1:401 E ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3242
Practice Address - Country:US
Practice Address - Phone:202-698-9021
Practice Address - Fax:202-698-9103
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant