Provider Demographics
NPI:1396194122
Name:FRAZIER, LESLIE (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:FRAZIER
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 1:497 AZALEA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7901
Mailing Address - Country:US
Mailing Address - Phone:662-337-8148
Mailing Address - Fax:
Practice Address - Street 1:497 AZALEA DR STE 102
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7901
Practice Address - Country:US
Practice Address - Phone:662-337-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical