Shirley Lee
Individual provider Active NPI Physician Assistant · Crownpoint, NM
NPI 1003939638 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003939638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- NCCPA-790632 (NM)
- Practice address
- Highway 371 Junction Route 9
Crownpoint, NM 87313 - Phone
- (505) 786-5291
- Fax
- (505) 786-6440
- NPI assigned
- Apr 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NCCPA-790632 | NM | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NCCPA-790632 | NM | Yes |
Addresses
Primary practice location
Highway 371 Junction Route 9
Crownpoint, NM 87313
Mailing address
PO Box 358
Crownpoint, NM 87313-0358
Phone (505) 786-5291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R5428 | Medicaid | NM |
Other providers in Crownpoint, NM
- Abraham V Kalathil
- Monica Freund Kaufman
- Verna Ann Kenneth
- Kinyaani Home Care LLC
- Donald Kulas
- Maria A Leon-Gandara
- Matthew Liaw
- Christopher Looney
- Elizabeth Lynch
- Alfred Matthew Macaltao
All providers in Crownpoint, NM · Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.