Provider Demographics
NPI:1396990909
Name:WALTERS, LEIGH ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:WALTERS
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 1:1951 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WARDENSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26851-8428
Mailing Address - Country:US
Mailing Address - Phone:304-897-7003
Mailing Address - Fax:
Practice Address - Street 1:8 LEE STREET
Practice Address - Street 2:POTOMAC VALLEY FAMILY MEDICINE
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-538-7707
Practice Address - Fax:304-538-7706
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013836Medicaid
WV2031444Medicare PIN
WV2031443Medicare PIN
WV2031445Medicare PIN
WV2031446Medicare PIN
WV2031442Medicare PIN
WV2031441Medicare PIN