Provider Demographics
NPI:1881965648
Name:LEONARD, AUDRA SHAY (PA-C)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:SHAY
Last Name:LEONARD
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 1:1301 W WALL ST STE C
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6605
Mailing Address - Country:US
Mailing Address - Phone:432-570-4500
Mailing Address - Fax:432-522-2115
Practice Address - Street 1:1301 W WALL ST STE C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6605
Practice Address - Country:US
Practice Address - Phone:432-570-4500
Practice Address - Fax:432-522-2115
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06974363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical