Provider Demographics
NPI:1417933813
Name:ACKLEY, LEE EDWARD (PA-C, MPAS, RT(R))
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:EDWARD
Last Name:ACKLEY
Suffix:
Gender:M
Credentials:PA-C, MPAS, RT(R)
Other - Prefix:
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Mailing Address - Street 1:901 INDIANA AVE
Mailing Address - Street 2:STE 540
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6734
Mailing Address - Country:US
Mailing Address - Phone:940-696-0011
Mailing Address - Fax:940-696-2248
Practice Address - Street 1:4412 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4719
Practice Address - Country:US
Practice Address - Phone:940-696-0011
Practice Address - Fax:940-696-2248
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical