Provider Demographics
NPI:1104545169
Name:LEBLANC, MEGAN ALYSE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALYSE
Last Name:LEBLANC
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2223 S BUCKNER BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-8635
Mailing Address - Country:US
Mailing Address - Phone:214-206-4706
Mailing Address - Fax:888-637-7896
Practice Address - Street 1:2223 S BUCKNER BLVD STE 229
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8635
Practice Address - Country:US
Practice Address - Phone:214-206-4706
Practice Address - Fax:888-637-7896
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA333126363A00000X
TXPA18848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant