Provider Demographics
NPI:1457907602
Name:LESTER, TERA M
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:M
Last Name:LESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2134
Mailing Address - Country:US
Mailing Address - Phone:580-634-2332
Mailing Address - Fax:580-634-2338
Practice Address - Street 1:1313 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2134
Practice Address - Country:US
Practice Address - Phone:580-634-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator