Provider Demographics
NPI:1386300531
Name:DENSON, LESTER JAY JR
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:JAY
Last Name:DENSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 TIMBERLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0514
Mailing Address - Country:US
Mailing Address - Phone:903-373-4575
Mailing Address - Fax:
Practice Address - Street 1:2533 TIMBERLAKE CIR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0514
Practice Address - Country:US
Practice Address - Phone:903-373-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX967130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse