Healthcare Provider Details

I. General information

NPI: 1831006923
Provider Name (Legal Business Name): LEA BAILEY LIGHTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 N SHORE DR
HILLSBORO OH
45133-9751
US

IV. Provider business mailing address

2729 RAINBOW TRL
WAVERLY OH
45690-9231
US

V. Phone/Fax

Practice location:
  • Phone: 937-402-5491
  • Fax: 937-661-6069
Mailing address:
  • Phone: 740-804-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010537RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: