Healthcare Provider Details

I. General information

NPI: 1124347752
Provider Name (Legal Business Name): BELINDA KESTERSON PC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E WALNUT LAWN SUITE 201
SPRINGFIELD MO
65807
US

IV. Provider business mailing address

960 E WALNUT LAWN SUITE 201
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4450
  • Fax: 417-269-8333
Mailing address:
  • Phone: 417-269-4450
  • Fax: 417-269-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2005013494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: