Individual
KATHERINE A LESTITIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506
(304) 293-4180
(304) 293-5845
Mailing address
PO BOX 9238, MORGANTOWN, WV 26506-9238
(304) 293-4180
(304) 293-5845
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA052238
PA
363AS0400X
Surgical Physician Assistant
Primary
0528
WV
363AS0400X
Surgical Physician Assistant
MA052238
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1560682
GATEWAY-WMG
PA
01
—
1945153
HIGHMARK BLUE SHIELD
PA
01
—
50067315
CAPITAL BLUE CROSS-WMG
PA
Enumeration date
06/16/2006
Last updated
01/11/2021
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