Healthcare Provider Details

I. General information

NPI: 1942421110
Provider Name (Legal Business Name): KENNETH ROBERT LEYMEISTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 DEL PRADO BLVD S STE 3
CAPE CORAL FL
33990-2676
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9960
  • Fax: 239-424-4006
Mailing address:
  • Phone: 239-343-9960
  • Fax: 239-424-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9116539
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA003414L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: