Healthcare Provider Details

I. General information

NPI: 1831107713
Provider Name (Legal Business Name): LEANNE MAYS PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 114
WASHINGTON DC
20016-4384
US

IV. Provider business mailing address

2333 ALEXANDRIA DR
LEXINGTON KY
40504-3215
US

V. Phone/Fax

Practice location:
  • Phone: 855-850-0638
  • Fax: 855-474-8005
Mailing address:
  • Phone: 800-320-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200002536
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112003
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA921
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004685
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: