Individual
LESLIE RENE ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 S LIMESTONE, LEXINGTON, KY 40506-0007
(859) 323-5901
(859) 323-3040
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA980
KY
363AM0700X
Medical Physician Assistant
PA980
KY
363AS0400X
Surgical Physician Assistant
PA980
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000512514
ANTHEM BCBS
KY
05
—
7100032550
—
KY
01
—
DB9578
RAILROAD MEDICARE GROUP
KY
01
—
P00454184
RAILROAD MEDICARE PTAN
KY
Enumeration date
11/21/2006
Last updated
08/01/2022
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