Healthcare Provider Details

I. General information

NPI: 1760054795
Provider Name (Legal Business Name): LKESHIA CHERIE ENDSLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3373 BARTLETT AVE
CONYERS GA
30013-7506
US

IV. Provider business mailing address

3373 BARTLETT AVE
CONYERS GA
30013-7506
US

V. Phone/Fax

Practice location:
  • Phone: 770-940-3084
  • Fax:
Mailing address:
  • Phone: 706-474-5285
  • Fax: 229-218-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP231725
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN231725
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: