Provider Demographics
NPI:1811284607
Name:LEE, JESSICA NICOLE (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 SW SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4833
Mailing Address - Country:US
Mailing Address - Phone:816-809-4509
Mailing Address - Fax:
Practice Address - Street 1:3808 SW SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4833
Practice Address - Country:US
Practice Address - Phone:816-809-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-37247207R00000X
MO2014014081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine