JESSICA SUZAHNE LEIST (NPI# 1174778286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174778286 |
| Entity Type | Individual |
| Full Name | JESSICA SUZAHNE LEIST |
| Credential | PA-C |
| Practice Address |
4709 66th St Lubbock TX 79414-4877 |
| Practice Telephone | 8067015844 |
| Practice Fax Number | 8067015845 |
| Mailing Telephone | 8067015844 |
| Mailing Fax Number | 8067015845 |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2020-04-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA06925 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 085.003344 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3601 4th St, Lubbock, TX 794303396 | 8067432373 |
| Street Address |
4709 66TH ST |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79414-4877 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740279330 | Coenant Health System | Home Health | 4709 66th St, Lubbock, TX 79414-4841 | 2005-10-17 |
| 1891332292 | Clayton Lee Brackeen | Nurse Practitioner | 4709 66th St, Lubbock, TX 79414-4877 | 2019-12-04 |
| 1922463959 | Skin Cancer Institute Pllc | Dermatology | 4709 66th St, Lubbock, TX 79414-4877 | 2015-12-17 |
| 1922290592 | Jeffrey Scott Brackeen | Dermatology | 4709 66th St, Lubbock, TX 79414-4877 | 2007-08-16 |
| 1427036417 | Amy Rocky Brackeen | Dermatology | 4709 66th St, Lubbock, TX 79414-4877 | 2006-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275182032 | Ensight Vision LLC | Optometrist | 6002 Slide Road, Lubbock, TX 79414 | 2019-09-05 |
| 1932697604 | Lone Star Mobile Med | Family Medicine | 5504 Wayne Ave Ste 105, Lubbock, TX 79414 | 2018-04-27 |
| 1679986806 | Nicole Evans-taylor | Pharmacist | 4847 Slide Road, Lubbock, TX 79414 | 2014-06-05 |
| 1679911697 | Jamel Deshane Vaughn | Optometrist | 6002 Slide Rd Ste P-8, Lubbock, TX 79414 | 2013-06-12 |
| 1659663284 | Vision One Associates | Optometrist | 6221 Slide Road, Lubbock, TX 79414 | 2011-05-16 |
| 1154445963 | C M Davis Od Pllc | Optometrist | 6002 Slide Road Suite P-8, Lubbock, TX 79414 | 2007-03-19 |
| 1922154632 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 5602 Slide Road, Lubbock, TX 79414 | 2007-01-26 |
| 1043393846 | Emily Rose Bohn | Physical Therapist | 3501 S. Loop 289, Lubbock, TX 79414 | 2006-10-23 |
| 1720176928 | Vann Alexander Home Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 5313 50th Street, Suite D-5, Lubbock, TX 79414 | 2006-10-11 |
| 1952499279 | Bradley Derl Brooks | Dentist | 5301 50th Street #200, Lubbock, TX 79414 | 2006-10-11 |
| Find all providers in zip 79414 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316294408 | Ronald Caporale | Physician Assistant | 1701 50th Street, Lubbock, TX 79412 | 2012-08-08 |
| 1699002675 | Jamie Fletcher | Physician Assistant | 5415 114th St, Lubbock, TX 79424 | 2009-11-11 |
| 1710160700 | Jessica Ferguson | Physician Assistant | 3606 21st St Ste 200, Lubbock, TX 79410-1225 | 2007-12-12 |
| 1104958560 | Janice Hallford Lampe | Physician Assistant | 6048 Marsha Sharp Fwy, Lubbock, TX 79407-3726 | 2007-03-12 |
| 1699819953 | Holly Jen Tyson | Physician Assistant | 3811 24th St, Lubbock, TX 79410-1813 | 2007-02-19 |
| 1154496974 | Kathleen Jo Marcum | Physician Assistant | 3801 21st St, Suite 200, Lubbock, TX 79410-1006 | 2006-11-21 |
| 1336252220 | Gustavo Alonso Bendeck | Physician Assistant | 4010 22nd St, Lubbock, TX 79410-1116 | 2006-08-16 |
| 1316903875 | Kristina Lee | Physician Assistant | 3904 101st St, Lubbock, TX 79423-5725 | 2006-04-25 |
| 1467416636 | David Anthony King | Physician Assistant | 3514 21st Street, Lubbock, TX 79410 | 2006-04-14 |
| 1346246634 | Phyllis Rose Peterson | Physician Assistant | Ttuhsc Dept of Psychiatry, 3601 4th St., Ms 8103, Lubbock, TX 79430-8103 | 2005-06-22 |
| Find all providers in LUBBOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.