Healthcare Provider Details

I. General information

NPI: 1821910910
Provider Name (Legal Business Name): FREDERICK LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CHESTER ST
LITTLE ROCK AR
72201-2015
US

IV. Provider business mailing address

14201 KANIS RD APT 831
LITTLE ROCK AR
72223-4969
US

V. Phone/Fax

Practice location:
  • Phone: 501-943-5600
  • Fax:
Mailing address:
  • Phone: 501-943-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: