Healthcare Provider Details

I. General information

NPI: 1356151518
Provider Name (Legal Business Name): RAMONA KILKENNY-LESTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 LAWRENCEVILLE HWY
LAWRENCEVILLE GA
30044-7710
US

IV. Provider business mailing address

3463 HAWTHORN FARM BLVD
LOGANVILLE GA
30052-5758
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-5878
  • Fax:
Mailing address:
  • Phone: 973-610-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN302648
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: