Provider Demographics
NPI:1982116331
Name:ROSS, LEE CHRISTOPHER (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:CHRISTOPHER
Last Name:ROSS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 CROWELL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7618
Mailing Address - Country:US
Mailing Address - Phone:843-813-2118
Mailing Address - Fax:
Practice Address - Street 1:526 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1319
Practice Address - Country:US
Practice Address - Phone:803-245-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5207Medicaid
SCSCC955OtherMEDICARE