Provider Demographics
NPI:1831107713
Name:MAYS, LEANNE (PAC)
Entity Type:Individual
Prefix:MISS
First Name:LEANNE
Middle Name:
Last Name:MAYS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3215
Mailing Address - Country:US
Mailing Address - Phone:800-320-9765
Mailing Address - Fax:
Practice Address - Street 1:2333 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3215
Practice Address - Country:US
Practice Address - Phone:800-320-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005799Medicaid
KY95005799Medicaid
0206133Medicare ID - Type Unspecified
Q52376Medicare UPIN
KY5499Medicare PIN
KY9765Medicare PIN