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NPI Code Detail

MEDICARE: BRIANNA KESTLE

MEDICARE: BRIANNA KESTLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1265079321
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA KESTLE
Provider Business Mailing Address
First Line : 3730 EDISON LAKES PKWY
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-3424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1550 PIDCO DR
Second Line :
City : PLYMOUTH
State : IN
Zip : 46563-1355
Country : US
Telephone Number : 574-387-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2019
Last Update Date : 12/06/2019

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Directions to “ BRIANNA KESTLE ” Practice Location

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