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General NPI Number Information
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NPI Number | 1821700592
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Entity Type | Individual
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Provider Name | JIN KIM LEE A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 11501 PAGE SERVICE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3530
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Country | US
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Telephone | 314-993-3014
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Fax | 314-993-2065
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Provider Business Mailing Address
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Address Line | 11501 PAGE SERVICE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3530
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Country | US
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Telephone | 314-993-3014
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Fax | 314-993-2065
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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 | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 2022040714
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License Number State | MO
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