Provider Demographics
NPI:1740202142
Name:O'CONNOR, LEIGH A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:A
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1240 N BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3016
Mailing Address - Country:US
Mailing Address - Phone:417-326-6021
Mailing Address - Fax:417-326-6347
Practice Address - Street 1:1240 N BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3016
Practice Address - Country:US
Practice Address - Phone:417-326-6021
Practice Address - Fax:417-326-6347
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004016561363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ40848Medicare UPIN