Provider Demographics
NPI:1932363462
Name:MCLEOD, LORI LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LEE
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11700 STUDT AVE
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7480
Mailing Address - Country:US
Mailing Address - Phone:314-989-9199
Mailing Address - Fax:
Practice Address - Street 1:11700 STUDT AVE
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7480
Practice Address - Country:US
Practice Address - Phone:314-989-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025052363A00000X, 363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical