Healthcare Provider Details

I. General information

NPI: 1730946385
Provider Name (Legal Business Name): MISTY DAWN LEE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY COLEMAN

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 NEW HOLT RD
PADUCAH KY
42001-7404
US

IV. Provider business mailing address

5050 VILLAGE SQUARE DR STE B
PADUCAH KY
42001-7552
US

V. Phone/Fax

Practice location:
  • Phone: 270-310-9200
  • Fax: 270-477-0007
Mailing address:
  • Phone: 270-310-9200
  • Fax: 270-477-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4016687
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: