MEDICARE: KENDRA L MCLESTER CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	RN117155	GA

General Provider Information

NPI Number	:	1194788034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA L MCLESTER CNM

Provider Business Mailing Address
First Line	:	64 SUMMER LEIGH DR
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5897
Country	:	US
Telephone Number	:	770-389-9447
Fax Number	:	770-785-5080

Provider Business Practice Location Address
First Line	:	155 MEDICAL WAY
Second Line	:	SUITE B
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4940
Country	:	US
Telephone Number	:	770-909-5003
Fax Number	:	770-909-5004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	04/22/2010

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