Provider Demographics
NPI:1205945953
Name:REA, LEE K (NP)
Entity type:Individual
Prefix:MRS
First Name:LEE
Middle Name:K
Last Name:REA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:K
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-626-2618
Mailing Address - Fax:530-626-2839
Practice Address - Street 1:5137 GOLDEN FOOTHILL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9671
Practice Address - Country:US
Practice Address - Phone:916-933-8010
Practice Address - Fax:530-748-0322
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15172363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00300968OtherRAILROAD MEDICARE
CARN638985Medicaid
CANP0151720OtherBLUE SHIELD
CANP0151720OtherBLUE SHIELD
CARN638985Medicaid
CAZZZ04440ZMedicare PIN