Provider Demographics
NPI:1821264599
Name:BARNETT, LEANN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:ROSE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:VILMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:517 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-744-2393
Practice Address - Fax:252-744-0013
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00593363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC182PNOtherBCBS OF NC
NCNCE851BOtherMEDICARE
NC1821264599Medicaid