Provider Demographics
NPI:1366435323
Name:YTURRI, LEAH DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DAWN
Last Name:YTURRI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:DAWN
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2501 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5281
Mailing Address - Country:US
Mailing Address - Phone:512-416-7246
Mailing Address - Fax:512-275-2833
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:SUITE 400
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-416-7246
Practice Address - Fax:512-275-2833
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189010504Medicaid
TX189010503Medicaid
TXTXB146718Medicare PIN
TXTXB152777Medicare PIN