Provider Demographics
NPI:1447409420
Name:LEE, JENNIFER CULPEPPER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CULPEPPER
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MEDICAL PLAZA PL
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3330
Mailing Address - Country:US
Mailing Address - Phone:318-377-7134
Mailing Address - Fax:318-377-7098
Practice Address - Street 1:382 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:LA
Practice Address - Zip Code:71073-2985
Practice Address - Country:US
Practice Address - Phone:318-382-0909
Practice Address - Fax:318-382-0914
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2149083Medicaid