Healthcare Provider Details

I. General information

NPI: 1114895216
Provider Name (Legal Business Name): AMBREA LEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 MAIN ST
ZACHARY LA
70791-4038
US

IV. Provider business mailing address

6351 MAIN ST
ZACHARY LA
70791-4038
US

V. Phone/Fax

Practice location:
  • Phone: 225-206-4168
  • Fax: 225-658-1249
Mailing address:
  • Phone:
  • Fax: 225-658-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number242939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: