1700940947 NPI number — MS. KRISTIN E KESTERSON RD, LMNT, CDE

Table of content: MS. KRISTIN E KESTERSON RD, LMNT, CDE (NPI 1700940947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700940947 NPI number — MS. KRISTIN E KESTERSON RD, LMNT, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KESTERSON
Provider First Name:
KRISTIN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LMNT, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORTENSON
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700940947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1116 MISSISSIPPI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69301-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-762-5766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 BOX BUTTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69301-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-762-6660
Provider Business Practice Location Address Fax Number:
308-762-1923
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  606 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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