Provider Demographics
NPI:1699378398
Name:LESTER, TARA NICOLE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:LESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5088 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1536
Mailing Address - Country:US
Mailing Address - Phone:681-217-2081
Mailing Address - Fax:
Practice Address - Street 1:1004 JOHN NORMAN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1258
Practice Address - Country:US
Practice Address - Phone:304-346-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator