Provider Demographics
NPI:1972569390
Name:DILL, LESLYE (PA)
Entity type:Individual
Prefix:
First Name:LESLYE
Middle Name:
Last Name:DILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1226
Mailing Address - Country:US
Mailing Address - Phone:888-878-6881
Mailing Address - Fax:620-728-0823
Practice Address - Street 1:1625 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1226
Practice Address - Country:US
Practice Address - Phone:888-878-6881
Practice Address - Fax:620-728-0823
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042836OtherBLUE CROSS BLUE SHIELD
KS100408690BMedicaid
KS448560OtherFIRST GUARD
KS100408690BMedicaid
KS970024239Medicare PIN
KS448560OtherFIRST GUARD