Provider Demographics
NPI:1194788034
Name:MCLESTER, KENDRA L (CNM)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:MCLESTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SUMMER LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5897
Mailing Address - Country:US
Mailing Address - Phone:770-389-9447
Mailing Address - Fax:770-785-5080
Practice Address - Street 1:155 MEDICAL WAY
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4940
Practice Address - Country:US
Practice Address - Phone:770-909-5003
Practice Address - Fax:770-909-5004
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117155176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife