Provider Demographics
NPI:1235259151
Name:WILLIAMS, LEE PUCKETT
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:PUCKETT
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 BEN ALI CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4222
Mailing Address - Country:US
Mailing Address - Phone:270-689-1695
Mailing Address - Fax:270-689-1695
Practice Address - Street 1:2305 BEN ALI CT
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4222
Practice Address - Country:US
Practice Address - Phone:270-689-1695
Practice Address - Fax:270-689-1695
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist