Healthcare Provider Details

I. General information

NPI: 1245826239
Provider Name (Legal Business Name): DEREK KYLE LESTER MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD
CROSS LANES WV
25313-6602
US

IV. Provider business mailing address

314 GOFF MOUNTAIN RD STE 3
CROSS LANES WV
25313-6600
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7070
  • Fax:
Mailing address:
  • Phone: 304-388-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number107968
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: