Healthcare Provider Details

I. General information

NPI: 1033583695
Provider Name (Legal Business Name): KATHLEEN LEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN JOHNSON

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 24TH ST STE 504
LUBBOCK TX
79410-1805
US

IV. Provider business mailing address

1400 WALLACE BLVD
AMARILLO TX
79106-1708
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-7700
  • Fax: 806-743-7703
Mailing address:
  • Phone: 806-414-9800
  • Fax: 806-354-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number805081
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP129251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: