Provider Demographics
NPI:1588112528
Name:PECHARICH, LESLIE ANN (MSPAS, PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:PECHARICH
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 TOWNSEND DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-4122
Mailing Address - Country:US
Mailing Address - Phone:970-397-4499
Mailing Address - Fax:
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0620
Practice Address - Country:US
Practice Address - Phone:970-405-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2074363AM0700X
COPA.0004864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical