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NPI Code Detail

MEDICARE: JENNIFER E LEIBOLD PA-C

MEDICARE: JENNIFER E LEIBOLD PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant50.001562OH
23747P1801XPersonal Care Attendant
3363A00000XPhysician Assistant50001562OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962710103
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER E LEIBOLD PA-C
Provider Business Mailing Address
First Line : 1430 OAK CT STE 100
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45430-1064
Country : US
Telephone Number : 937-404-1101
Fax Number : 937-404-1210
Provider Business Practice Location Address
First Line : 5491 FAR HILLS AVE
Second Line :
City : DAYTON
State : OH
Zip : 45429-2325
Country : US
Telephone Number : 937-436-5763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2010
Last Update Date : 03/05/2026

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Directions to “ JENNIFER E LEIBOLD PA-C” Practice Location

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