Provider Demographics
NPI:1396922779
Name:BAYLISS, LEAH HOPE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:HOPE
Last Name:BAYLISS
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 1:2018 EBONY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-5025
Mailing Address - Country:US
Mailing Address - Phone:832-922-3839
Mailing Address - Fax:
Practice Address - Street 1:2018 EBONY LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-5025
Practice Address - Country:US
Practice Address - Phone:832-922-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05645363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8336OtherBCBSTX
TXPA05645OtherSTATE LICENSE
TX8L3711Medicare PIN