Provider Demographics
NPI:1801483490
Name:LESOINE, ABIGAIL (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LESOINE
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 1:510 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY TOP
Mailing Address - State:TN
Mailing Address - Zip Code:37769-2818
Mailing Address - Country:US
Mailing Address - Phone:865-205-9582
Mailing Address - Fax:865-205-9583
Practice Address - Street 1:510 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769-2818
Practice Address - Country:US
Practice Address - Phone:865-205-9582
Practice Address - Fax:865-205-9583
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027970363AM0700X, 363A00000X
TN6003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical