Provider Demographics
NPI:1326092321
Name:RODRIGUEZ, LEE E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4500 ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-9063
Mailing Address - Country:US
Mailing Address - Phone:417-529-5047
Mailing Address - Fax:
Practice Address - Street 1:69300 NEE RD
Practice Address - Street 2:
Practice Address - City:QUAPAW
Practice Address - State:OK
Practice Address - Zip Code:74363-2134
Practice Address - Country:US
Practice Address - Phone:918-919-6114
Practice Address - Fax:918-919-6115
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424768414Medicaid