Provider Demographics
NPI:1891806568
Name:JOHNSON, LEIGH ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:LOHOEFENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-407-5490
Mailing Address - Fax:816-407-5491
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 308
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-407-5490
Practice Address - Fax:816-407-5491
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009028275363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891806568OtherNPI