Provider Demographics
NPI:1104450154
Name:CARTER, LEANNE METZGER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:METZGER
Last Name:CARTER
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 1:4747 DUSTY LAKE DR STE G1
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-9056
Mailing Address - Country:US
Mailing Address - Phone:870-536-6600
Mailing Address - Fax:870-541-8623
Practice Address - Street 1:4747 DUSTY LAKE DR STE G1
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-9056
Practice Address - Country:US
Practice Address - Phone:870-536-6600
Practice Address - Fax:870-541-8623
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant