Healthcare Provider Details

I. General information

NPI: 1184773426
Provider Name (Legal Business Name): HEIDI T. KESTNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

10213 CONOVER DR
SILVER SPRING MD
20902-4847
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4122
  • Fax: 202-537-0158
Mailing address:
  • Phone: 301-593-7755
  • Fax: 202-537-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA54
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: