Healthcare Provider Details

I. General information

NPI: 1003405838
Provider Name (Legal Business Name): LESLEY ANNE DEJARNETTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 S SEMINOLE TRL
MADISON VA
22727-2690
US

IV. Provider business mailing address

13198 JAMES MADISON HWY
ORANGE VA
22960-2808
US

V. Phone/Fax

Practice location:
  • Phone: 540-672-3010
  • Fax:
Mailing address:
  • Phone: 540-672-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-007504
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: