Basic Information
| Provider Information | |||||||||
| NPI: | 1194208454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | CNM, WHNP, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 E ASHLEY VALLEY LN | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840926124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8011657124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 NORTHSIDE FORSYTH DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300418483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2018 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN280751 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.