=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356151518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMONA KILKENNY-LESTER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2025
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2169 LAWRENCEVILLE HWY
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-676-5878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3463 HAWTHORN FARM BLVD
-----------------------------------------------------
City | LOGANVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30052-5758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-610-3827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | RN302648
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------