Provider Demographics
NPI:1114370418
Name:SIMON, LEE M (NP)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:M
Last Name:SIMON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16158 AIRLINE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4212
Mailing Address - Country:US
Mailing Address - Phone:225-963-9355
Mailing Address - Fax:225-314-9355
Practice Address - Street 1:16158 AIRLINE HWY STE 103
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4212
Practice Address - Country:US
Practice Address - Phone:225-963-9355
Practice Address - Fax:225-314-9355
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08855363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty