Provider Demographics
NPI:1740756287
Name:REAP, LESLIE ACACIA (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ACACIA
Last Name:REAP
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ACACIA
Other - Last Name:FARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2807 N WALKER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1345
Mailing Address - Country:US
Mailing Address - Phone:405-446-9850
Mailing Address - Fax:
Practice Address - Street 1:2807 N WALKER AVE STE 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1345
Practice Address - Country:US
Practice Address - Phone:405-446-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant