Provider Demographics
NPI:1750960977
Name:KEYSER, LESLIE ADAM (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ADAM
Last Name:KEYSER
Suffix:
Gender:M
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 1:461 WESTERN BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7637
Mailing Address - Country:US
Mailing Address - Phone:910-333-0283
Mailing Address - Fax:910-333-0513
Practice Address - Street 1:461 WESTERN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7637
Practice Address - Country:US
Practice Address - Phone:910-333-0283
Practice Address - Fax:910-333-0513
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant