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General NPI Number Information
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NPI Number | 1508669888
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Entity Type | Individual
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Provider Name | LEE ANN LYNN MANGUM APRN
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Gender | Female
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1108 GLENSBORO RD.
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City | LAWRENCEBURG
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State | KY
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Zip | 40342
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Country | US
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Telephone | 502-598-3042
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Fax | 502-598-3184
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Provider Business Mailing Address
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Address Line | 615 RIDGE CREST DR
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City | HARRODSBURG
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State | KY
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Zip | 40330-8309
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Country | US
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Telephone | 859-612-9112
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4036930
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License Number State | KY
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