Provider Demographics
NPI:1972197101
Name:LEE, LAUREN (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-9154
Mailing Address - Country:US
Mailing Address - Phone:270-206-7114
Mailing Address - Fax:
Practice Address - Street 1:249 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9154
Practice Address - Country:US
Practice Address - Phone:270-206-7114
Practice Address - Fax:270-206-7116
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100741900Medicaid