Provider Demographics
NPI:1700390283
Name:EAVES, LESLEY BROOKE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:BROOKE
Last Name:EAVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 BROWNING PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6504
Mailing Address - Country:US
Mailing Address - Phone:618-697-8808
Mailing Address - Fax:
Practice Address - Street 1:107 W HARGETT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1700
Practice Address - Country:US
Practice Address - Phone:984-255-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant