LESLIE IRENE BURNSIDE (NPI# 1760451454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760451454 |
| Entity Type | Individual |
| Full Name | LESLIE IRENE BURNSIDE |
| Credential | PA-C |
| Practice Address |
147 W Chubbuck Rd Chubbuck ID 83202-2314 |
| Practice Telephone | 2082387546 |
| Practice Fax Number | 2082379643 |
| Mailing Telephone | 2082387546 |
| Mailing Fax Number | 2082379643 |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2014-07-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA-645 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363A00000X | Physician Assistant | PA518 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807303300 | 05 | |
| ID | BLUE CROSS | PAA34 | 01 |
| ID | REGENCE BLUE SHIELD | 000010152873 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407490048 | Leslie Burnside | Counselor | 600 N Blackwelder Ave Apt 24, Edmond, OK 73034-5167 | 2019-11-06 |
| 1720283088 | Leslie Burnside | Counselor | 6307 Honegger Dr, Charlotte, NC 28211-4716 | 2007-06-18 |
| Street Address |
147 W CHUBBUCK RD |
| City | CHUBBUCK |
| State | ID |
| Zip Code | 83202-2314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558756106 | Trevor Batty | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2015-03-31 |
| 1972745594 | Stoddard Medical, Inc | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2009-03-27 |
| 1720195530 | Ryan T Mcculloch | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-08-25 |
| 1992716674 | Amy Louise Mckinlay | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-08-10 |
| 1760400238 | Earl Stoddard | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700379682 | Vera Whole Health, Wa PC | Clinic/Center | 219 Phil Meador Ave, Pocatello, ID 83202 | 2018-06-14 |
| 1649712597 | Angie M Mccurdy | Audiologist | 4155 Yellowstone Hwy, Pine Ridge Mall, Pocatello, ID 83202 | 2016-11-09 |
| 1285180836 | Beverly Grigg Jones | Counselor | 210 W. Burnside, Chubbuck, ID 83202 | 2016-09-01 |
| 1376992503 | Andrea Walsh | Nurse Practitioner | 1133 Call Creek Dr, Ste A, Pocatello, ID 83202 | 2016-06-08 |
| 1215381181 | Specialized Physical Therapy Pllc | Clinic/Center | 4141 Poleline Rd Ste A, Pocatello, ID 83202 | 2016-04-18 |
| 1457713588 | Jennifer Ann Gould | Radiologic Technologist | 907 Ryan Street, Chubbuck, ID 83202 | 2016-03-28 |
| 1154714897 | Phoenix Management LLC | Day Training, Developmentally Disabled Services | 10991 Deerridge Dr., Chubbuck, ID 83202 | 2015-03-05 |
| 1750781449 | Jennifer Lynn Seaich | Counselor | 4460 Center Way, Center Counseling, Pocatello, ID 83202 | 2014-08-29 |
| 1336562412 | Kurt Layton | Counselor | 337 Joel, Chubbuck, ID 83202 | 2014-01-27 |
| 1245653468 | Hannah's Place LLC | Occupational Therapist | 240 W Burnside Ave Ste D, Chubbuck, ID 83202 | 2014-01-23 |
| Find all providers in zip 83202 | ||||
| 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 |
|---|---|---|---|---|
| 1437469830 | Rachel M Koster | Physician Assistant | 4650 Hawthorne Road, Suite 3b, Chubbuck, ID 83202 | 2010-10-19 |
| 1053502955 | Renee Lynn Katter | Physician Assistant | 4460 Kings Way Ste 3, Chubbuck, ID 83202-1900 | 2007-08-06 |
| 1740650548 | Brent Leavitt | Physician Assistant | 4928 Pleasant View Dr, Chubbuck, ID 83202-1640 | 2015-10-06 |
| 1720195530 | Ryan T Mcculloch | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-08-25 |
| 1992716674 | Amy Louise Mckinlay | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821695792 | Chelsea Dylan Tennent | Physician Assistant | 1666 E Gentlewind St, Boise, ID 83706-5914 | 2020-10-05 |
| 1922615848 | Allison Cluff | Physician Assistant | 1320 Bennett Ave, Burley, ID 83318-2665 | 2020-09-24 |
| 1245846187 | Adam Baker | Physician Assistant | 271 Jefferson St, Blackfoot, ID 83221-1818 | 2020-09-16 |
| 1265045199 | Julia Claire Brodie | Physician Assistant | 2352 N Apple Ln, Pocatello, ID 83204-7231 | 2020-08-29 |
| 1326651035 | Jenna Marie Castillo | Physician Assistant | 150 Taft Ave, Pocatello, ID 83201-5140 | 2020-08-24 |
| 1174148696 | Colton Jason Randall | Physician Assistant | 3885 Orchard Cir, Ammon, ID 83406-4656 | 2020-06-10 |
| 1871114553 | Samantha Tess Goodrich | Physician Assistant | 721 E Lenz St, Boise, ID 83712-7846 | 2020-05-04 |
| 1174164305 | Tessie Mari Mcinnally | Physician Assistant | 3015 E Magic View Dr # 115, Meridian, ID 83642-3743 | 2019-09-29 |
| 1013562305 | Brianna Suzanne Berg | Physician Assistant | 12535 N Fawn Ct, Hayden, ID 83835-8827 | 2019-08-05 |
| 1003376559 | Kodie Thomas | Physician Assistant | 2086 Picket Ln, Emmett, ID 83617-9104 | 2019-03-21 |
| Find all providers with the same taxonomy | ||||
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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.