Provider Demographics
NPI:1205951100
Name:LES, KERRY T (RN, WHCNP)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:T
Last Name:LES
Suffix:
Gender:F
Credentials:RN, WHCNP
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:TWITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, WHCNP
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-2166
Mailing Address - Fax:207-662-6308
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2166
Practice Address - Fax:207-662-6308
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER037643363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q19194Medicare UPIN
MENP462201Medicare PIN