Healthcare Provider Details

I. General information

NPI: 1003843376
Provider Name (Legal Business Name): KESTAHL & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MOUNTAIN LAUREL
CHAPEL HILL NC
27517-7615
US

IV. Provider business mailing address

590 MOUNTAIN LAUREL
CHAPEL HILL NC
27517-7615
US

V. Phone/Fax

Practice location:
  • Phone: 919-542-5673
  • Fax:
Mailing address:
  • Phone: 919-542-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166286
License Number StateNC

VIII. Authorized Official

Name: MRS. CRYSTAL LADD ANDERSON
Title or Position: VACCINE COORDINATOR
Credential: R.N.
Phone: 919-542-5673