Provider Demographics
NPI:1790704427
Name:LEE, KAREN L (RN, PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:RN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 E LOHMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3194
Mailing Address - Country:US
Mailing Address - Phone:575-800-5902
Mailing Address - Fax:575-888-4136
Practice Address - Street 1:1980 E LOHMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3194
Practice Address - Country:US
Practice Address - Phone:575-800-5902
Practice Address - Fax:575-888-4136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR38297163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65621271Medicaid