Provider Demographics
NPI:1972188035
Name:LEKE, OLIVE NKOUAYE (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVE
Middle Name:NKOUAYE
Last Name:LEKE
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 296
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-0296
Mailing Address - Country:US
Mailing Address - Phone:910-421-0100
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:1521 OWEN PARK LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3454
Practice Address - Country:US
Practice Address - Phone:910-223-7420
Practice Address - Fax:910-223-7452
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant