Provider Demographics
NPI:1316049125
Name:LEE, KRISTEN (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3502
Mailing Address - Country:US
Mailing Address - Phone:828-694-7630
Mailing Address - Fax:828-694-7631
Practice Address - Street 1:800 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3410
Practice Address - Country:US
Practice Address - Phone:828-696-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45102207R00000X
NC2011-01790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN067K6STOtherBLUE CROSS MN PRO FEE
WI34374300Medicaid
MN560645400Medicaid
0405620OtherMEDICA
MN067K5STOtherBLUE CROSS MN FACILITY
NCNC3973BOtherMEDICARE
P00017814OtherRAILROAD
583781299OtherCHAMPUS TRICARE
HP38557OtherHEALTHPARTNERS
NA9031034591OtherPREFERREDONE