Healthcare Provider Details

I. General information

NPI: 1639332794
Provider Name (Legal Business Name): 48 MDG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDOS/SGOW UNIT 5210 BOX 230
APO AE
09461
US

IV. Provider business mailing address

PSC 41 BOX 3799
APO AE
09464-0038
US

V. Phone/Fax

Practice location:
  • Phone: 01638528603
  • Fax:
Mailing address:
  • Phone: 402-210-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberPY 5848
License Number StateFL

VIII. Authorized Official

Name: DR. DAWN ELIZABETH KESSLER-WALKER
Title or Position: BEHAVIORAL HEALTH FLIGHT COMMANDER
Credential: PHD
Phone: 402-210-2463