Provider Demographics
NPI:1669950598
Name:FARRELL, LESLEY (PA-C)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:FARRELL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9357
Mailing Address - Country:US
Mailing Address - Phone:260-266-1000
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 114
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7360
Practice Address - Country:US
Practice Address - Phone:919-570-7660
Practice Address - Fax:919-570-7661
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003622A363A00000X
NC0010-08303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant