Provider Demographics
NPI:1326860693
Name:LONGFIELD, LEXADY BURKE (PA-C)
Entity type:Individual
Prefix:
First Name:LEXADY
Middle Name:BURKE
Last Name:LONGFIELD
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 1:14455 W VAN BUREN ST # 100
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9209
Mailing Address - Country:US
Mailing Address - Phone:623-518-2386
Mailing Address - Fax:
Practice Address - Street 1:14455 W VAN BUREN ST # 100
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9209
Practice Address - Country:US
Practice Address - Phone:623-518-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12554501-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant