Provider Demographics
NPI:1194113860
Name:LOVETTE, LESLIE GENEVA (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:GENEVA
Last Name:LOVETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:LOVETTE-LOCKLEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1705 BERWICK DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5550
Mailing Address - Country:US
Mailing Address - Phone:910-610-4368
Mailing Address - Fax:910-610-4388
Practice Address - Street 1:1705 BERWICK DR STE B
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5550
Practice Address - Country:US
Practice Address - Phone:910-610-4368
Practice Address - Fax:910-610-4388
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant