Provider Demographics
NPI:1699158618
Name:PAXTON, LEIGH THACKSTON (PA)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:THACKSTON
Last Name:PAXTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LEIGH
Other - Middle Name:ANNE
Other - Last Name:THACKSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7240 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5741
Mailing Address - Country:US
Mailing Address - Phone:503-477-6700
Mailing Address - Fax:
Practice Address - Street 1:7240 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5741
Practice Address - Country:US
Practice Address - Phone:503-477-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA172112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant