Healthcare Provider Details

I. General information

NPI: 1396194122
Provider Name (Legal Business Name): LESLIE FRAZIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 BELK BLVD
OXFORD MS
38655-1992
US

IV. Provider business mailing address

735 BELK BLVD
OXFORD MS
38655-1992
US

V. Phone/Fax

Practice location:
  • Phone: 662-337-8148
  • Fax:
Mailing address:
  • Phone: 662-337-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: