Provider Demographics
NPI:1821470113
Name:WEISS, LESLEY E (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:E
Last Name:WEISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:E
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:424 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1400
Mailing Address - Country:US
Mailing Address - Phone:304-767-7870
Mailing Address - Fax:304-767-7879
Practice Address - Street 1:424 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1400
Practice Address - Country:US
Practice Address - Phone:304-767-7870
Practice Address - Fax:304-767-7879
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1920363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical