Provider Demographics
NPI:1013287564
Name:LESTELLE, KIMBERLY A (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:A
Last Name:LESTELLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-3422
Mailing Address - Country:US
Mailing Address - Phone:504-442-5767
Mailing Address - Fax:
Practice Address - Street 1:1300 CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-3422
Practice Address - Country:US
Practice Address - Phone:504-442-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA5051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist