Provider Demographics
NPI:1306264536
Name:LEIGHTNER, MEGHAN CAROLINE
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CAROLINE
Last Name:LEIGHTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:CAROLINE
Other - Last Name:LAMOTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:844 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-261-0700
Mailing Address - Fax:757-962-7217
Practice Address - Street 1:844 KEMPSVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-261-0700
Practice Address - Fax:757-962-7217
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical