Provider Demographics
NPI:1588162002
Name:LEE, KIMBERLY ANTONETTE (FNP-C; PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANTONETTE
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C; PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 W 120TH ST STE E242
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3395
Mailing Address - Country:US
Mailing Address - Phone:424-223-0421
Mailing Address - Fax:323-305-3402
Practice Address - Street 1:10511 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4458
Practice Address - Country:US
Practice Address - Phone:424-789-4919
Practice Address - Fax:323-305-3405
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007992363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily