Individual
MRS. DENISE A. LEACH
Active
Individual
MRS. DENISE A. LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
00415
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001804180
MTN STATE BC/BS SERVICE
WV
01
—
001804181
MTN STATE BC/BS PAY TO 1
WV
01
—
001967359
MTN STATE BC/BS PAY TO 2
WV
01
—
1023728
NCCPA
WV
01
—
3001225
BRICKSTREET WORKERS COMP
WV
01
—
30543
WV RN LICENSE
WV
01
—
328667
CARELINK
WV
05
—
3810005319
—
WV
01
—
FQ415
HEALTH PLAN PROVIDER
WV
01
—
P00670309
RAILROAD MEDICARE PTAN
—
Enumeration date
02/21/2006
Last updated
03/07/2023
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