Healthcare Provider Details

I. General information

NPI: 1447114871
Provider Name (Legal Business Name): CAMMIE LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 SMOKE RANCH RD STE A
LAS VEGAS NV
89128-3157
US

IV. Provider business mailing address

241 VERTIGO TULIP CT
LAS VEGAS NV
89106-3984
US

V. Phone/Fax

Practice location:
  • Phone: 702-320-8111
  • Fax:
Mailing address:
  • Phone: 702-728-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: