Provider Demographics
NPI:1588294995
Name:LEE, PAULA RENE (NP-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:RENE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S TYLER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2353
Mailing Address - Country:US
Mailing Address - Phone:985-892-9143
Mailing Address - Fax:985-892-9656
Practice Address - Street 1:1203 S TYLER ST STE 200
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-892-9143
Practice Address - Fax:985-892-9656
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner