Provider Demographics
NPI:1760762553
Name:LECKEY, LEIGHANN (PA)
Entity Type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:
Last Name:LECKEY
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 1:1125 EVERGREEN ROAD
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958
Mailing Address - Country:US
Mailing Address - Phone:814-472-8052
Mailing Address - Fax:
Practice Address - Street 1:1125 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SUMMERHILL
Practice Address - State:PA
Practice Address - Zip Code:15958-5018
Practice Address - Country:US
Practice Address - Phone:814-472-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051658363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical