Provider Demographics
NPI:1942249743
Name:LEE, HEATHER T (APN, GCNS-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:APN, GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5649
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928
Mailing Address - Country:US
Mailing Address - Phone:865-804-5306
Mailing Address - Fax:865-689-1981
Practice Address - Street 1:5112 MALIBU DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918
Practice Address - Country:US
Practice Address - Phone:865-804-5306
Practice Address - Fax:865-689-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000110919363L00000X
TNAPN7432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0106OtherJOHN DEERE
TN3347074Medicaid
TN4042440OtherBLUE CROSS
TN3347074Medicare PIN
TNTN0106OtherJOHN DEERE
TN3347074Medicaid