Healthcare Provider Details

I. General information

NPI: 1033927199
Provider Name (Legal Business Name): AMANDA KESTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 RUSTY RD NW
ALBUQUERQUE NM
87114-4138
US

IV. Provider business mailing address

1742 RUSTY RD NW
ALBUQUERQUE NM
87114-4138
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-6653
  • Fax:
Mailing address:
  • Phone: 505-328-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65404
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: