Provider Demographics
NPI:1295490910
Name:SPIRES, LESLIE (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SPIRES
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 429
Mailing Address - Street 2:
Mailing Address - City:MER ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:71261-0429
Mailing Address - Country:US
Mailing Address - Phone:318-647-5008
Mailing Address - Fax:318-647-9956
Practice Address - Street 1:301 DAVENPORT AVENUE
Practice Address - Street 2:
Practice Address - City:MER ROUGE
Practice Address - State:LA
Practice Address - Zip Code:71261
Practice Address - Country:US
Practice Address - Phone:318-647-5008
Practice Address - Fax:318-647-9956
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA329034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant