Active NPI
Maria Stella Lee, PA
- Physician Assistant
- Fort Campbell, KY
National Provider Identifier
1508049461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1541
- Practice address
- 650 Joel Dr
Blanchfield Army Community Hospital
Fort Campbell, KY 42223-5318 - Phone
- (314) 744-4280
- NPI assigned
- Dec 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1541 | TN | Primary |
Addresses
Primary practice location
650 Joel Dr
Blanchfield Army Community Hospital
Fort Campbell, KY 42223-5318
Mailing address
12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345
Phone (314) 744-4280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190820001085 | TN | Order and Referring Only - Family Practice | 2365770096 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1541 | TN | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197504000000",
"number": "1508049461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "SUITE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416345",
"telephone_number": "314-744-4280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"address_2": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "314-744-4280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MARIA",
"middle_name": "STELLA",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-13",
"last_updated": "2007-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "1541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.