Healthcare Provider Details

I. General information

NPI: 1730725292
Provider Name (Legal Business Name): TRACEY L LESTER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MOUNTAINEER HWY
BRADSHAW WV
24817
US

IV. Provider business mailing address

512 MOUNTAINEER HWY
BRADSHAW WV
24817
US

V. Phone/Fax

Practice location:
  • Phone: 304-967-7682
  • Fax: 304-967-7684
Mailing address:
  • Phone: 304-967-7682
  • Fax: 304-967-7684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4002397
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: