Provider Demographics
NPI:1982891818
Name:FREEMAN, LEIGH ELLEN (PA-C, MMS)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ELLEN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ELLEN
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MMS
Mailing Address - Street 1:105 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-9998
Mailing Address - Country:US
Mailing Address - Phone:919-467-5543
Mailing Address - Fax:919-469-2391
Practice Address - Street 1:105 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-9998
Practice Address - Country:US
Practice Address - Phone:919-467-5543
Practice Address - Fax:919-469-2391
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001026363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001001026OtherNC LICENSE