Provider Demographics
NPI:1255968103
Name:LEE, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2179
Mailing Address - Country:US
Mailing Address - Phone:615-438-5640
Mailing Address - Fax:
Practice Address - Street 1:2410 PATTERSON ST STE 500
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6521
Practice Address - Country:US
Practice Address - Phone:615-342-7440
Practice Address - Fax:615-342-7455
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN177041163W00000X
TN30580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse