Healthcare Provider Details

I. General information

NPI: 1356020051
Provider Name (Legal Business Name): TAMIEKA LEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HILLS PLZ
CHARLESTON WV
25387-2438
US

IV. Provider business mailing address

116 HILLS PLZ
CHARLESTON WV
25387-2438
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6999
  • Fax:
Mailing address:
  • Phone: 304-760-6336
  • Fax: 304-720-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number117268
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117268
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number93394
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: