Healthcare Provider Details

I. General information

NPI: 1104745660
Provider Name (Legal Business Name): NICKEASHA KADIA LECESNE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICKEASHA KADIA KERR-LECESNE NP

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 CORNELIA ST
BROOKLYN NY
11221-5104
US

IV. Provider business mailing address

149 CORNELIA ST
BROOKLYN NY
11221-5104
US

V. Phone/Fax

Practice location:
  • Phone: 917-371-9874
  • Fax:
Mailing address:
  • Phone: 917-371-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360072-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: