Basic Information
| Provider Information | |||||||||
| NPI: | 1194788034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLESTER | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 SUMMER LEIGH DR | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703899447 | ||||||||
| FaxNumber: | 7707855080 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 MEDICAL WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302744940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709095003 | ||||||||
| FaxNumber: | 7709095004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 04/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | RN117155 | GA | Y | Other Service Providers | Midwife |
No ID Information.