Provider Demographics
NPI:1942216296
Name:LEE, NANCY (PA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12221 N. MOPAC EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-901-4011
Mailing Address - Fax:512-901-3911
Practice Address - Street 1:12221 N. MOPAC EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2483
Practice Address - Country:US
Practice Address - Phone:512-901-4011
Practice Address - Fax:512-901-3911
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186837401Medicaid
TXP00426944Medicare PIN
TXE55114Medicare UPIN
TX8J8895Medicare PIN