Healthcare Provider Details

I. General information

NPI: 1497032544
Provider Name (Legal Business Name): LEAH MCMORRIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 MAIN ST SUITE B1
ZACHARY LA
70791-3943
US

IV. Provider business mailing address

5408 FLANDERS DR
BATON ROUGE LA
70808-9168
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5597
  • Fax: 225-761-5270
Mailing address:
  • Phone: 225-769-5554
  • Fax: 225-761-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA200468
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: