Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP129251 | TX |
N | 363LP0200X | Nurse Practitioner - Pediatrics | C142378 | IA |
NPI | 1033583695 |
---|---|
Provider Name | Kathleen Lee |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2015 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05102707 | (05) | NM |
200750990A | (05) | OK |
380691101 | (05) | TX |
380691102 | (05) | TX |