Provider Demographics
NPI:1427648906
Name:LEE, AMY LAUREN (CRNA, DNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LAUREN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, DNP
Mailing Address - Street 1:302 W LEAKE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4130
Mailing Address - Country:US
Mailing Address - Phone:601-317-8484
Mailing Address - Fax:
Practice Address - Street 1:1030 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9553
Practice Address - Country:US
Practice Address - Phone:601-932-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901685367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered