=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881559292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE LESTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2025
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 BLYTHE BLVD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28203-5812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-355-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7226 E 1100TH ST
-----------------------------------------------------
City | MACOMB
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61455-8188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-313-4698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------