MR. MATELAND LESTERY KEITH III (NPI# 1457964843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457964843 |
| Entity Type | Individual |
| Full Name | MR. MATELAND LESTERY KEITH III |
| Practice Address |
8309 Denver Dr Avon IN 46123-0123 |
| Practice Telephone | 3175149139 |
| Mailing Telephone | 3175149139 |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2020-08-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
28243714A | IN | Nursing Service Providers |
| N | 163WP0807X |
Registered Nurse Specialization: Psych/Mental Health, Child & Adolescent |
28243714A | IN | Nursing Service Providers |
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
28243714A | IN | Nursing Service Providers |
| N | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
28243714A | IN | Nursing Service Providers |
| Street Address |
8309 DENVER DR |
| City | AVON |
| State | IN |
| Zip Code | 46123-0123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669018669 | Dienye Williams | Pharmacist | 108 North Sr 267, Avon, IN 46123 | 2019-11-25 |
| 1992353817 | Debra Blackwell | Technician | 8198 Montage Ave, Apt 104, Avon, IN 46123 | 2019-09-04 |
| 1932675766 | Blake Ponist | Occupational Therapist | 10940 E U S Highway 36, Rockville Rd, Avon, IN 46123 | 2018-10-19 |
| 1396238150 | Sarah Sweany | Dietitian, Registered | Iu Health West Cancer Center, 1111 North Ronald Reagen Pkwy Suite B1600, Avon, IN 46123 | 2018-06-07 |
| 1124516257 | Sheree Itza | Counselor | 6655 E Us Highway 36 Ste 100, Avon, IN 46123 | 2018-04-24 |
| 1255860607 | Jonathan Lambert | Dentist | 110 N Avon Ave B, Avon, IN 46123 | 2017-06-08 |
| 1023546629 | 10439 E Us Highway 36 Dental, LLC | Dentist | 10439 E Us Highway 36, Avon, IN 46123 | 2017-05-25 |
| 1902330756 | Melissa Wheatley | Occupational Therapy Assistant | 6294 Forest View Court, Avon, IN 46123 | 2017-04-19 |
| 1932555844 | Gal Marcan | Family Medicine | 1351 Ronald Reagan Pkwy Ste B, Avon, IN 46123 | 2016-05-10 |
| 1962871301 | Annette Joelene Oechsle | Health Educator | 1820 South County Road 525 East, Avon, IN 46123 | 2015-09-16 |
| Find all providers in zip 46123 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164082137 | Sheila Anne Lewicki | Registered Nurse | 37782 Hatteras Way, Avon, OH 44011-2194 | 2019-06-20 |
| 1245470830 | Judith Scharnak | Registered Nurse | 6655 East Us 36, Avon, IN 46123 | 2009-02-23 |
| 1306897913 | Kathy Santon | Registered Nurse | 192 N State Road 267, Suite 300, Avon, IN 46123-9513 | 2006-05-16 |
| 1174055438 | Peterson Psychiatric Services, LLC | Registered Nurse | 4265 E Main St, Avon, IN 46123-9174 | 2017-03-28 |
| 1760639819 | Carissa Ann Tufano | Registered Nurse | 21 Waterville Rd, Harvest Healthcare, Avon, CT 06001-2097 | 2008-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447886957 | Jessica Lynn Walsh | Registered Nurse | 4910 Oakbrook Ct, Indianapolis, IN 46254-1116 | 2020-03-16 |
| 1194361352 | Cassandra Jo Lind | Registered Nurse | 2521 Cardinal Dr, Pittsboro, IN 46167-9559 | 2019-11-22 |
| 1831506922 | Kimberli Galloway | Registered Nurse | 127 Winding Creek Ct, Fishers, IN 46038-1075 | 2014-07-21 |
| 1780838557 | Kathleen M Whitaker | Registered Nurse | 209 W North St, Lebanon, IN 46052 | 2008-11-06 |
| 1841467859 | Dana L Porter Brown | Registered Nurse | 1 N Barker Ave, Evansville, IN 47712-5601 | 2008-05-09 |
| 1528170842 | Caroline Virginia Voors | Registered Nurse | 1615 Vance Ave, Lmvfm, Fort Wayne, IN 46805 | 2006-08-31 |
| 1083648083 | Susan Jeanine Slone | Registered Nurse | 258 Meadow Dr, Danville, IN 46122 | 2006-07-10 |
| 1316910367 | Thelma Lynn Young-bolden | Registered Nurse | 4323 E 3rd St, Bloomington, IN 47401-5551 | 2006-02-09 |
| 1043818396 | Jessica Lynn Handy | Registered Nurse | 2525 W University Ave, Muncie, IN 47303-3421 | 2020-10-09 |
| 1356957641 | Wendy Bodwell | Registered Nurse | 833 E Main St, Albion, IN 46701-1302 | 2020-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.