Provider Demographics
NPI:1962071415
Name:THOMAS, LESLEIGH JOHANN (PA)
Entity type:Individual
Prefix:MRS
First Name:LESLEIGH
Middle Name:JOHANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LESLEIGH
Other - Middle Name:JOHANN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1085 NE GATEWAY CT NE STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 NE GATEWAY CT NE STE 180
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2407
Practice Address - Country:US
Practice Address - Phone:704-707-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-20
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962071415Medicaid