Provider Demographics
NPI:1083928436
Name:LEZOTTE, KELLEE ANN (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLEE
Middle Name:ANN
Last Name:LEZOTTE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4439
Mailing Address - Country:US
Mailing Address - Phone:248-672-4178
Mailing Address - Fax:
Practice Address - Street 1:1791 HARWOOD DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4439
Practice Address - Country:US
Practice Address - Phone:248-672-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145231163W00000X
MI2019332363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse