Provider Demographics
NPI:1437480480
Name:LECKIE, JENNIFER DAWN (PA-C, LAC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:LECKIE
Suffix:
Gender:F
Credentials:PA-C, LAC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:407 N BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5710
Mailing Address - Country:US
Mailing Address - Phone:803-995-8936
Mailing Address - Fax:803-995-8851
Practice Address - Street 1:407 N BROWN ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5710
Practice Address - Country:US
Practice Address - Phone:803-995-8936
Practice Address - Fax:803-995-8851
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3433363A00000X
SC269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist