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NPI Code Detail

MEDICARE: KRISTEN M LEE PA

MEDICARE: KRISTEN M LEE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant085004658IL
2363A00000XPhysician AssistantPA9118247FL
3363A00000XPhysician Assistant085004658IL

General Provider Information

NPI Number : 1649216789
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN M LEE PA
Provider Business Mailing Address
First Line : PO BOX 9727
Second Line :
City : PEORIA
State : IL
Zip : 61612-9727
Country : US
Telephone Number : 309-886-9172
Fax Number :
Provider Business Practice Location Address
First Line : 1312 MANATEE AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1358
Country : US
Telephone Number : 941-708-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2006
Last Update Date : 07/10/2025

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Directions to “ KRISTEN M LEE PA” Practice Location

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