Provider Demographics
NPI:1194091934
Name:WILSON, LEIGH HERRIN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:HERRIN
Last Name:WILSON
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 1:11651 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3932
Mailing Address - Country:US
Mailing Address - Phone:806-280-0534
Mailing Address - Fax:
Practice Address - Street 1:11651 JOLLYVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3931
Practice Address - Country:US
Practice Address - Phone:806-280-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07748363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical