Healthcare Provider Details

I. General information

NPI: 1104545169
Provider Name (Legal Business Name): MEGAN ALYSE LEBLANC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LITTLE RD
ARLINGTON TX
76017-1058
US

IV. Provider business mailing address

4700 LITTLE RD
ARLINGTON TX
76017-1058
US

V. Phone/Fax

Practice location:
  • Phone: 214-206-4706
  • Fax: 888-635-4503
Mailing address:
  • Phone: 214-206-4706
  • Fax: 888-635-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number333126
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA18848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: