=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962325035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE DANIELLE NESTOR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2026
-----------------------------------------------------
Last Update Date | 08/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54 ACJC DR
-----------------------------------------------------
City | BEVERLY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26253-4705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-246-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 BREWSTER LN
-----------------------------------------------------
City | BEVERLY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26253-4884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 112916
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------