MEDICARE: KENIA VICTORIA LEE PNP

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	363LP1700X	Perinatal Nurse Practitioner	AP110044	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598763450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENIA VICTORIA LEE PNP

Provider Business Mailing Address
First Line	:	801 W 1ST ST
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-2276
Country	:	US
Telephone Number	:	956-787-8915
Fax Number	:	956-787-2021

Provider Business Practice Location Address
First Line	:	806 W 3RD ST
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589
Country	:	US
Telephone Number	:	956-787-8915
Fax Number	:	956-787-2021

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/31/2018

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