Provider Demographics
NPI:1881204162
Name:LEE, KRISTIAN PATRICIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIAN
Middle Name:PATRICIA
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:PATRICIA
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-783-3343
Mailing Address - Fax:270-780-0476
Practice Address - Street 1:201 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1708
Practice Address - Country:US
Practice Address - Phone:270-783-3343
Practice Address - Fax:270-780-0476
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100692160Medicaid