Provider Demographics
NPI:1518490887
Name:LESSARD, KRISTEL (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTEL
Middle Name:
Last Name:LESSARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 DALEY ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-4807
Mailing Address - Country:US
Mailing Address - Phone:770-733-0684
Mailing Address - Fax:224-298-0079
Practice Address - Street 1:609 DALEY ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-4807
Practice Address - Country:US
Practice Address - Phone:770-733-0684
Practice Address - Fax:224-298-0079
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR063589207R00000X
WYTL8218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine