Provider Demographics
NPI:1851071021
Name:WILSON, LEAH MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:PA
Mailing Address - Zip Code:16210-0091
Mailing Address - Country:US
Mailing Address - Phone:724-954-9890
Mailing Address - Fax:
Practice Address - Street 1:10261 STATE ROUTE 85
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8165
Practice Address - Country:US
Practice Address - Phone:724-783-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant