Provider Demographics
NPI:1346035938
Name:LEE, DERIK (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:DERIK
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7596 S 2480 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3825
Mailing Address - Country:US
Mailing Address - Phone:801-613-0041
Mailing Address - Fax:
Practice Address - Street 1:7596 S 2480 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3825
Practice Address - Country:US
Practice Address - Phone:801-613-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6033331-4405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine