Provider Demographics
NPI:1679870356
Name:HORNBERGER, LESLIE (PA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HORNBERGER
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 1:2760 VIRGINIA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4964
Mailing Address - Country:US
Mailing Address - Phone:469-587-7546
Mailing Address - Fax:214-544-6737
Practice Address - Street 1:2760 VIRGINIA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4964
Practice Address - Country:US
Practice Address - Phone:469-587-7546
Practice Address - Fax:214-544-6737
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01160311OtherRAILROAD MEDICARE
TXP01160311OtherRAILROAD MEDICARE