Provider Demographics
NPI:1902597263
Name:LEE, TAYLOR NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 KINZALOW DR
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-3233
Mailing Address - Country:US
Mailing Address - Phone:423-519-1398
Mailing Address - Fax:
Practice Address - Street 1:517 KINZALOW DR
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-3233
Practice Address - Country:US
Practice Address - Phone:423-519-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant