Provider Demographics
NPI:1316485667
Name:LEE, KATHRYN (PA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MCVAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:466 JACK KRAMER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4342
Mailing Address - Country:US
Mailing Address - Phone:913-961-7547
Mailing Address - Fax:
Practice Address - Street 1:6025 WALNUT GROVE RD STE 301
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2123
Practice Address - Country:US
Practice Address - Phone:901-226-0456
Practice Address - Fax:901-226-0458
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3164363AS0400X
MSPA00503363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical