Provider Demographics
NPI:1740435965
Name:WRIGHT, LESLIE JADE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JADE
Last Name:WRIGHT
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 1:14206 DRYBURGH CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2225
Mailing Address - Country:US
Mailing Address - Phone:704-900-0252
Mailing Address - Fax:
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-900-0252
Practice Address - Fax:980-636-6518
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101169Medicaid
NC8101169Medicaid