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General NPI Number Information
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NPI Number | 1588278006
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Entity Type | Individual
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Provider Name | SHAYLA LEE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 665 S PEAR ORCHARD RD STE 106-591
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 480-608-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 665 S PEAR ORCHARD RD STE 106-591
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 904122
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 249203
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License Number State | AZ
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