Healthcare Provider Details

I. General information

NPI: 1689925893
Provider Name (Legal Business Name): REGINA LEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 MAIN ST STE A
COLLINS MS
39428-6197
US

IV. Provider business mailing address

309 MAIN ST STE A
COLLINS MS
39428-6197
US

V. Phone/Fax

Practice location:
  • Phone: 601-641-4070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR865513
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: