Basic Information
Provider Information
NPI: 1518273366
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: BRIDGET
MiddleName: M
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10540 MARTY ST
Address2: STE 100
City: OVERLAND PARK
State: KS
PostalCode: 662122551
CountryCode: US
TelephoneNumber: 9136601616
FaxNumber:  
Practice Location
Address1: 17065 SOUTH 71 HIGHWAY
Address2:  
City: BELTON
State: MO
PostalCode: 64012
CountryCode: US
TelephoneNumber: 8163481200
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/30/2010
LastUpdateDate: 11/24/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X53-75207-091KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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