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General NPI Number Information
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NPI Number | 1639771355
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Entity Type | Individual
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Provider Name | KATHY K KERSTEN RPH
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 2401 AVONDALE HASLET RD
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City | HASLET
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State | TX
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Zip | 76052-3221
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Country | US
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Telephone | 817-302-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 605 BAREBACK LN
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City | FORT WORTH
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State | TX
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Zip | 76131-3121
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Country | US
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Telephone | 806-336-1402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 024627
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License Number State | TX
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