Provider Demographics
NPI:1932674645
Name:LEE, KRISTEN E (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:O
Other - Last Name:TINDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1204 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2710
Mailing Address - Country:US
Mailing Address - Phone:843-673-0122
Mailing Address - Fax:843-661-6400
Practice Address - Street 1:1204 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2710
Practice Address - Country:US
Practice Address - Phone:843-673-0122
Practice Address - Fax:843-661-6400
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily