Healthcare Provider Details

I. General information

NPI: 1114680063
Provider Name (Legal Business Name): JENNIFER ANN LESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 5TH AVE STE 4
HUNTINGTON WV
25701-1907
US

IV. Provider business mailing address

3439 NORWOOD RD
HUNTINGTON WV
25705-4039
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-9678
  • Fax:
Mailing address:
  • Phone: 304-633-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number70675
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: