Basic Information
Provider Information | |||||||||
NPI: | 1194076836 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEE | ||||||||
FirstName: | APRIL | ||||||||
MiddleName: | LAKESHIA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1309 | ||||||||
Address2: |   | ||||||||
City: | CANTON | ||||||||
State: | MS | ||||||||
PostalCode: | 390461309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6018599888 | ||||||||
FaxNumber: | 6018599966 | ||||||||
Practice Location | |||||||||
Address1: | 1171 HART ST | ||||||||
Address2: |   | ||||||||
City: | CANTON | ||||||||
State: | MS | ||||||||
PostalCode: | 390464805 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6018599888 | ||||||||
FaxNumber: | 6018599004 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2012 | ||||||||
LastUpdateDate: | 07/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R874728 | MS | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | R874728 | 01 | MS | MISSISSIPPI | OTHER |