Provider Demographics
NPI:1730432022
Name:ZACHARIAH, LESLEY R (PA-C)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:R
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 MEDICAL CENTER DR STE 312
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1604
Mailing Address - Country:US
Mailing Address - Phone:214-592-9955
Mailing Address - Fax:214-592-9935
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 312
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1604
Practice Address - Country:US
Practice Address - Phone:214-592-9955
Practice Address - Fax:214-592-9935
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX260305YKP5Medicare PIN
TX260305YKPWMedicare PIN
TX260305YKQLMedicare PIN