Provider Demographics
NPI:1104361070
Name:LEE-CARTER, ANNDEE N (PAC)
Entity Type:Individual
Prefix:
First Name:ANNDEE
Middle Name:N
Last Name:LEE-CARTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX S
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-1090
Mailing Address - Country:US
Mailing Address - Phone:405-567-4922
Mailing Address - Fax:405-567-4290
Practice Address - Street 1:1322 KLABZUBA AVE
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-4900
Practice Address - Country:US
Practice Address - Phone:405-567-4922
Practice Address - Fax:405-567-4290
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant