Basic Information
| Provider Information | |||||||||
| NPI: | 1851918718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1375 RIVERBEND DR APT 104 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376644075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195132902 | ||||||||
| FaxNumber: | 6195132902 | ||||||||
| Practice Location | |||||||||
| Address1: | 1990 HOLTON AVE E | ||||||||
| Address2: | |||||||||
| City: | BIG STONE GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242193350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766790321 | ||||||||
| FaxNumber: | 2766796095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0116034137 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0116034137 | 01 | VA | VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS LICENSING NUMBER | OTHER |