MEDICARE: MS. KAREN L. LEE RN, PMHCNS-BC

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	R38297	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R38297	NM

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	:	1790704427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN L. LEE RN, PMHCNS-BC

Provider Business Mailing Address
First Line	:	1980 E LOHMAN AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3194
Country	:	US
Telephone Number	:	575-800-5902
Fax Number	:	575-888-4136

Provider Business Practice Location Address
First Line	:	1980 E LOHMAN AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3194
Country	:	US
Telephone Number	:	575-800-5902
Fax Number	:	575-888-4136

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/03/2019

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