Provider Demographics
NPI:1477094241
Name:LEE, KINZIE JEAN (DNP)
Entity Type:Individual
Prefix:DR
First Name:KINZIE
Middle Name:JEAN
Last Name:LEE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FORTUNE WAY
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4920
Mailing Address - Country:US
Mailing Address - Phone:478-297-5782
Mailing Address - Fax:
Practice Address - Street 1:101 FORTUNE WAY
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-4920
Practice Address - Country:US
Practice Address - Phone:478-297-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2020-12-10
Deactivation Date:2018-04-09
Deactivation Code:
Reactivation Date:2020-12-10
Provider Licenses
StateLicense IDTaxonomies
GARN218996163WL0100X
GARN18996363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant