Leslie Erin Davis, PA
Individual provider Active NPI Physician Assistant · Vicksburg, MS
NPI 1053977249 · NPPES record last updated Dec 18, 2023
Key facts
- NPI
- 1053977249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00426 (MS)
- Practice address
- 1202 Mission Park Dr
Vicksburg, MS 39180-3758 - Phone
- (601) 738-5549
- NPI assigned
- May 14, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Vicksburg Nephrology LLC
Practice addresses (Care Compare)
104 Railroad Ave
Delta, LA 71233
Phone (601) 738-5549
1202 Mission Park Dr
Vicksburg, MS 39180-3758
Phone (601) 738-5549
2100 Hwy 61 N
Vicksburg, MS 39183-8211
Phone (601) 738-5549
Hospital & facility affiliations
- Merit Health River Region
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191203001355 | MS | Practitioner - Physician Assistant | 4587097647 | Reassigns benefits to 1 organization |
| I20260610003723 | LA | Practitioner - Physician Assistant | 4587097647 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology and Skin Cancer Clinic, P.a. | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GFEFCD/Endpoint/GFEFCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00426 | MS | Yes |
Addresses
Primary practice location
1202 Mission Park Dr
Vicksburg, MS 39180-3758
Mailing address
1202 Mission Park Dr
Vicksburg, MS 39180-3758
Phone (601) 738-5549
Other providers in Vicksburg, MS
- Daniel P Dare
- Rudella Davenport
- Tyla Davenport
- David M Halinski MD PC
- Christie Davis
- Michael L Davis
- Sherita Davis
- Donald Allan Dearman
- Jennifer Decker
- Megann Price Dees
All providers in Vicksburg, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.