Provider Demographics
NPI:1225349657
Name:SHOEMAKER, LEIGH KELLY (MS, PA-C)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:KELLY
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2060 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3029
Mailing Address - Country:US
Mailing Address - Phone:616-475-8446
Mailing Address - Fax:616-475-1272
Practice Address - Street 1:2060 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3029
Practice Address - Country:US
Practice Address - Phone:616-475-8446
Practice Address - Fax:616-475-1272
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005758363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical