Provider Demographics
NPI:1093413395
Name:LEE, LATONYA (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E EMMA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4685
Mailing Address - Country:US
Mailing Address - Phone:479-751-7417
Mailing Address - Fax:
Practice Address - Street 1:610 E EMMA AVE STE C
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4685
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223457363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health