Provider Demographics
NPI:1215028766
Name:KLEE, JACQUELINE (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KLEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 BAHAMA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:502-564-9784
Mailing Address - Fax:502-564-9586
Practice Address - Street 1:100 GLENNS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2473
Practice Address - Country:US
Practice Address - Phone:502-564-9784
Practice Address - Fax:502-564-9586
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2971P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P73259Medicare UPIN