Individual
LEE PACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP, OTR
Contact information
Practice address
6051 U S HIGHWAY 49, HATTIESBURG, MS 39401-7201
(601) 288-7000
Mailing address
2910 MAGNOLIA PL, HATTIESBURG, MS 39402-2428
(662) 610-0847
(601) 469-9965
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT1385
MS
363LF0000X
Family Nurse Practitioner
AP5005
AZ
363LF0000X
Family Nurse Practitioner
CNP-02475
NM
363LF0000X
Family Nurse Practitioner
Primary
R879013
MS
Other
Enumeration date
03/04/2011
Last updated
03/02/2021
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