Provider Demographics
NPI:1295345940
Name:LEE, KASEY DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:DANIELLE
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 1:411 S L ROGERS WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1191
Mailing Address - Country:US
Mailing Address - Phone:270-651-7796
Mailing Address - Fax:270-651-7074
Practice Address - Street 1:411 S L ROGERS WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1191
Practice Address - Country:US
Practice Address - Phone:270-651-7796
Practice Address - Fax:270-651-7074
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily