Provider Demographics
NPI:1740208297
Name:HARDING, LEEANNA SUE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:LEEANNA
Middle Name:SUE
Last Name:HARDING
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4479 ACORN HILL DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-0277
Mailing Address - Country:US
Mailing Address - Phone:803-367-1504
Mailing Address - Fax:
Practice Address - Street 1:9628 REA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6697
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1039363AM0700X
NC001000198363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q51806Medicare UPIN
NC2764135Medicare ID - Type Unspecified
NC2764135AMedicare PIN