Provider Demographics
NPI:1558392803
Name:LEE, CARLA A (ARNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 N WESTLINK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4238
Mailing Address - Country:US
Mailing Address - Phone:316-722-1595
Mailing Address - Fax:316-522-2551
Practice Address - Street 1:8415 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2607
Practice Address - Country:US
Practice Address - Phone:316-267-4663
Practice Address - Fax:316-522-2551
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200380010AMedicaid