MEDICARE: SHERITA LEE PMHNP-BC, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A005081	AR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	A005081	AR
3	261QM1300X	Multi-Specialty Clinic/Center	A005081	AR

General Provider Information

NPI Number	:	1215478375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERITA LEE PMHNP-BC, FNP-C

Provider Business Mailing Address
First Line	:	2007 FENDLEY DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-1806
Country	:	US
Telephone Number	:	501-246-3261
Fax Number	:	501-916-2776

Provider Business Practice Location Address
First Line	:	2007 FENDLEY DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-1806
Country	:	US
Telephone Number	:	501-246-3261
Fax Number	:	501-916-2776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	09/30/2025

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