Provider Demographics
NPI:1073160602
Name:LEE, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 N MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3950
Mailing Address - Country:US
Mailing Address - Phone:870-863-4508
Mailing Address - Fax:
Practice Address - Street 1:1232 N MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3950
Practice Address - Country:US
Practice Address - Phone:870-863-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider