Provider Demographics
NPI:1275924169
Name:PURTTHIPATKOOL, LEE-ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEE-ANN
Middle Name:
Last Name:PURTTHIPATKOOL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4929
Mailing Address - Country:US
Mailing Address - Phone:214-578-4976
Mailing Address - Fax:972-771-2849
Practice Address - Street 1:8144 WALNUT HILL LN STE 1350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4335
Practice Address - Country:US
Practice Address - Phone:972-598-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily