Healthcare Provider Details

I. General information

NPI: 1902068810
Provider Name (Legal Business Name): KARRIE K. LEIGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LEFEVRE RD
STERLING IL
61081-1278
US

IV. Provider business mailing address

100 E LEFEVRE RD
STERLING IL
61081-1278
US

V. Phone/Fax

Practice location:
  • Phone: 815-625-0400
  • Fax: 815-625-2747
Mailing address:
  • Phone: 815-625-0400
  • Fax: 815-625-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003233
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: