1255678884 NPI number — HEATHER MICHELLE LEE PA-C

Table of content: HEATHER MICHELLE LEE PA-C (NPI 1255678884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255678884 NPI number — HEATHER MICHELLE LEE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
HEATHER
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255678884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5306 NC HIGHWAY 55 STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-7812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-457-1517
Provider Business Mailing Address Fax Number:
919-363-7697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28734-2580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-524-7337
Provider Business Practice Location Address Fax Number:
828-369-1340
Provider Enumeration Date:
01/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  001004073 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 924304 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255678884 . This is a "DOCTORS DIRECT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1255678884 . This is a "HEALTHNET FEDERAL SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003139252A . This is a "PEACHCARE 4 KIDS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 3595612 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: FH1101575 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1255678884 . This is a "HEALTHSMART" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1255678884 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396618 . This is a "COVENTRY OF THE CAROLINAS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9048984 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 003139252A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13286553 . This is a "PHCS-MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1255678884 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1396618 . This is a "WELLPATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1772E . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 264075 . This is a "MEDCOST, LLC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2742033 . This is a "CIGNA GREATWEST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4243028 . This is a "COVENTRY NATIONAL - COVENTRY PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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