Provider Demographics
NPI:1770538498
Name:LEDBETTER, DENISE A (PA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3663
Mailing Address - Country:US
Mailing Address - Phone:541-828-8808
Mailing Address - Fax:
Practice Address - Street 1:229 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3663
Practice Address - Country:US
Practice Address - Phone:541-282-8808
Practice Address - Fax:541-618-6452
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant