Provider Demographics
NPI:1891358016
Name:BEECH, LEEANNA ALLYSON (PA)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:ALLYSON
Last Name:BEECH
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 1:631 W AVENUE Q
Mailing Address - Street 2:STE B
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3892
Mailing Address - Country:US
Mailing Address - Phone:901-545-8090
Mailing Address - Fax:901-545-6809
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-8090
Practice Address - Fax:901-545-6809
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3854363AS0400X, 363A00000X
CA59290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical