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General NPI Number Information
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NPI Number | 1316534597
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Entity Type | Individual
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Provider Name | MICAH LEE PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 11311 BRIDGEPORT WAY SW STE 100
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City | LAKEWOOD
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State | WA
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Zip | 98499-3096
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Country | US
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Telephone | 253-985-2949
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Fax | 253-985-2948
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Provider Business Mailing Address
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Address Line | 11311 BRIDGEPORT WAY SW STE 100
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City | LAKEWOOD
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State | WA
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Zip | 98499-3096
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Country | US
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Telephone | 253-985-2949
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Fax | 253-985-2948
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0011606
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61413217
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License Number State | WA
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