Healthcare Provider Details

I. General information

NPI: 1801786454
Provider Name (Legal Business Name): WADE KARL LEAVITT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WHIPPLE AVE STE 30
LOGANDALE NV
89021-9934
US

IV. Provider business mailing address

1301 BERTHA HOWE AVE STE 1
MESQUITE NV
89027-7503
US

V. Phone/Fax

Practice location:
  • Phone: 702-398-3621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0751
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3249
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: