Provider Demographics
NPI:1083378376
Name:LEE, TRICIA WILSON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:WILSON
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:RENA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8095 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-4121
Mailing Address - Country:US
Mailing Address - Phone:251-610-1995
Mailing Address - Fax:
Practice Address - Street 1:8095 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:AL
Practice Address - Zip Code:36544-4121
Practice Address - Country:US
Practice Address - Phone:251-610-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-087502OtherREGISTERED NURSE
2021028810OtherADULT GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
AL1-087502OtherCERTIFIED REGISTERED NURSE PRACTITIONER