Provider Demographics
NPI:1669787255
Name:LEE, JENNY ANNE (NP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-736-6133
Mailing Address - Fax:317-736-6403
Practice Address - Street 1:1159 W JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-736-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28140770A363L00000X, 363LF0000X
IN28140770163WX0002X, 163WX0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201354130Medicaid