Healthcare Provider Details

I. General information

NPI: 1245763358
Provider Name (Legal Business Name): KIM LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1161 21ST AVE S A-0118 MEDICAL CENTER NORTH
NASHVILLE TN
37232-0011
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number327761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: