Provider Demographics
NPI:1063766319
Name:LEONARD, MEG ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:MEG
Middle Name:ELIZABETH
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:ELIZABETH
Other - Last Name:PETRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1401 COOPERSHILL DR
Mailing Address - Street 2:UNIT 308
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-4524
Mailing Address - Country:US
Mailing Address - Phone:419-343-9625
Mailing Address - Fax:
Practice Address - Street 1:2460 CURTIS ELLIS DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2237
Practice Address - Country:US
Practice Address - Phone:252-962-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant