Provider Demographics
NPI:1528126588
Name:CORDILL, LEIGH ANNA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANNA
Last Name:CORDILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LEIGH
Other - Middle Name:ANNA
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4 BANCROFT CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5101
Mailing Address - Country:US
Mailing Address - Phone:318-388-0032
Mailing Address - Fax:318-388-0491
Practice Address - Street 1:4 BANCROFT CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5101
Practice Address - Country:US
Practice Address - Phone:318-388-0032
Practice Address - Fax:318-388-0491
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10310RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1709948Medicaid
LA573207Medicare UPIN
LA50477P201Medicare ID - Type Unspecified