Provider Demographics
NPI:1851591317
Name:LEE, LESLIE (FNP)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-3587
Mailing Address - Country:US
Mailing Address - Phone:731-203-1011
Mailing Address - Fax:731-967-8784
Practice Address - Street 1:844 NATCHEZ TRACE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4144
Practice Address - Country:US
Practice Address - Phone:731-203-1011
Practice Address - Fax:731-967-8784
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily