Healthcare Provider Details

I. General information

NPI: 1740208297
Provider Name (Legal Business Name): LEEANNA SUE HARDING PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 N BROOME ST
WAXHAW NC
28173-9378
US

IV. Provider business mailing address

4479 ACORN HILL DR
LANCASTER SC
29720-0277
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 803-367-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1039
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001000198
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: