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General NPI Number Information
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NPI Number | 1740435965
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Entity Type | Individual
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Provider Name | LESLIE JADE WRIGHT PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 309 S SHARON AMITY RD SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28211-2978
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Country | US
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Telephone | 704-900-0252
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Fax | 980-636-6518
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Provider Business Mailing Address
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Address Line | 14206 DRYBURGH CIR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-2225
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Country | US
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Telephone | 704-900-0252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01605
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License Number State | NC
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