Individual
JIN KIM LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A-GNP-C
Contact information
Practice address
11501 PAGE SERVICE DR, SAINT LOUIS, MO 63146-3530
(314) 993-3014
(314) 993-2065
Mailing address
11501 PAGE SERVICE DR, SAINT LOUIS, MO 63146-3530
(314) 993-3014
(314) 993-2065
Taxonomy
Speciality
Code
Description
License number
State
363LX0106X
Occupational Health Nurse Practitioner
Primary
2022040714
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007026654
RN LICENSE NUMBER
MO
01
—
2022040714
CNP LICENSE NUMBER
MO
Enumeration date
12/14/2022
Last updated
01/16/2024
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