Healthcare Provider Details

I. General information

NPI: 1508136375
Provider Name (Legal Business Name): LEIGH RICHARDS BOECKLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEIGH FARR RICHARDS PA-C

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6990 SMOKE RANCH RD
LAS VEGAS NV
89128-3119
US

IV. Provider business mailing address

2809 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1998
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9999
  • Fax:
Mailing address:
  • Phone: 702-476-9999
  • Fax: 702-946-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: