Provider Demographics
NPI:1770958027
Name:DE LEON, HAILEY BARKER (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:BARKER
Last Name:DE LEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2915 W BITTERS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2007
Mailing Address - Country:US
Mailing Address - Phone:210-598-2800
Mailing Address - Fax:
Practice Address - Street 1:2915 W BITTERS RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2007
Practice Address - Country:US
Practice Address - Phone:210-598-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant