Healthcare Provider Details

I. General information

NPI: 1649101098
Provider Name (Legal Business Name): BRANDON KOESTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST
KIRKSVILLE MO
63501-1443
US

IV. Provider business mailing address

3 GREENBRIAR MOORS CT
SAINT PETERS MO
63376-7766
US

V. Phone/Fax

Practice location:
  • Phone: 660-626-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: