Healthcare Provider Details

I. General information

NPI: 1205457595
Provider Name (Legal Business Name): KIMBERLY A LEE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 11/27/2023
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W MARKET ST
LIMA OH
45805-2120
US

IV. Provider business mailing address

2740 W MARKET ST
LIMA OH
45805-2120
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-2273
  • Fax: 419-879-2461
Mailing address:
  • Phone: 419-221-2273
  • Fax: 419-879-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0027498
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: