Provider Demographics
NPI:1104966837
Name:LEE, JANET TYCER (RN, MSN, ANP-C)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:TYCER
Last Name:LEE
Suffix:
Gender:F
Credentials:RN, MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 HIGHWAY 1046
Mailing Address - Street 2:P.O. BOX 156
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-7002
Mailing Address - Country:US
Mailing Address - Phone:985-748-7727
Mailing Address - Fax:
Practice Address - Street 1:15481 W CLUB DELUXE RD
Practice Address - Street 2:S. TANGIPAHOA PARISH HEALTH UNIT
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1466
Practice Address - Country:US
Practice Address - Phone:985-543-4170
Practice Address - Fax:985-543-4171
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN045429 AP03479363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1109673Medicaid