Provider Demographics
NPI:1649932880
Name:LESTER, KAYLA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:LESTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-1015
Mailing Address - Country:US
Mailing Address - Phone:304-799-4404
Mailing Address - Fax:304-799-4425
Practice Address - Street 1:821 3RD AVE
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954-1015
Practice Address - Country:US
Practice Address - Phone:304-799-4404
Practice Address - Fax:304-799-4425
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty