Provider Demographics
NPI:1457861148
Name:LEE, JAMES (NP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10959 WINROCK RD
Mailing Address - Street 2:
Mailing Address - City:MOORINGSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71060-8548
Mailing Address - Country:US
Mailing Address - Phone:318-393-4418
Mailing Address - Fax:
Practice Address - Street 1:1005 N EASTMAN RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4231
Practice Address - Country:US
Practice Address - Phone:903-247-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09580363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care