Healthcare Provider Details

I. General information

NPI: 1073101630
Provider Name (Legal Business Name): LEIA RENEE TARBOX CHE MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEIA RENEE TARBOX

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16538 W 159TH TER
OLATHE KS
66062-3924
US

IV. Provider business mailing address

16538 W 159TH TER
OLATHE KS
66062-3924
US

V. Phone/Fax

Practice location:
  • Phone: 913-355-8660
  • Fax:
Mailing address:
  • Phone: 913-355-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02946
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2021006544
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: