Individual
MRS. LEAH IVY PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4715 WHITESBURG DR SE, HUNTSVILLE, AL 35802-1649
(256) 881-5151
(256) 880-3939
Mailing address
4715 WHITESBURG DR SE, HUNTSVILLE, AL 35802-1649
(256) 881-5151
(256) 880-3939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2014005588
MO
363A00000X
Physician Assistant
Primary
PA.2107
AL
363A00000X
Physician Assistant
TL2808
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037PA
—
SC
01
—
PA.2107
MEDICAL LICENSE
AL
Enumeration date
03/05/2014
Last updated
09/21/2023
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