Basic Information
Provider Information
NPI: 1003452624
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LESTER
FirstName: ASHLEY
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: PMHNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6501 N CHARLES ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212046819
CountryCode: US
TelephoneNumber: 4109383000
FaxNumber:  
Practice Location
Address1: 6501 N CHARLES ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212046819
CountryCode: US
TelephoneNumber: 4109383000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/19/2019
LastUpdateDate: 06/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XR209720MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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