Healthcare Provider Details

I. General information

NPI: 1700857950
Provider Name (Legal Business Name): JAMIE MARIE KERSTEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 1003 BOX 8
FPO AE
09728
IS

IV. Provider business mailing address

PSC 1003 BOX 8
FPO AE
09728
IS

V. Phone/Fax

Practice location:
  • Phone: 0113544253230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00092754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: