Provider Demographics
NPI:1427411032
Name:MCCRARY, LEE ALISON (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ALISON
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-2302
Mailing Address - Country:US
Mailing Address - Phone:903-276-1390
Mailing Address - Fax:
Practice Address - Street 1:1102 S RUNNELS ST
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:TX
Practice Address - Zip Code:75559-2302
Practice Address - Country:US
Practice Address - Phone:903-276-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759747163W00000X
TXAP131753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse