Provider Demographics
NPI:1871927574
Name:LEE, JENNIFER (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:I
Other - Last Name:FITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3403 W T C JESTER BLVD # 1525
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-5044
Mailing Address - Country:US
Mailing Address - Phone:832-786-1004
Mailing Address - Fax:
Practice Address - Street 1:9432 KATY FWY # 460
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6349
Practice Address - Country:US
Practice Address - Phone:832-699-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-RXN.0100310-C-NP363LF0000X
NM74149363LP0808X
TXAP123821363LF0000X, 363LP0808X
COC-RXN.0100609-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324863501Medicaid
TX8776NDOtherBCBS
TX324863501Medicaid