Provider Demographics
NPI:1639337876
Name:LEE, KYUNG-HEE STELLA (MSN PNP)
Entity Type:Individual
Prefix:
First Name:KYUNG-HEE
Middle Name:STELLA
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N KING ST CLINICAL SERVICES
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004
Mailing Address - Country:US
Mailing Address - Phone:928-679-7222
Mailing Address - Fax:
Practice Address - Street 1:2625 N KING ST CLINICAL SERVICES
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-679-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1060163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ910431OtherAHCCCS
AZZFL500Medicare PIN