Healthcare Provider Details

I. General information

NPI: 1922527712
Provider Name (Legal Business Name): JULIE ANN LESTER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GLORIA TERRELL DR
WILDER KY
41076-9188
US

IV. Provider business mailing address

9023 LICKING PIKE
ALEXANDRIA KY
41001-9033
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-2800
  • Fax: 859-781-2800
Mailing address:
  • Phone: 859-781-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000090353
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: