Provider Demographics
NPI:1104939149
Name:KESTEN, KATHLEEN O'SHEA (CFNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:O'SHEA
Last Name:KESTEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:O'SHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:1691 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2203
Practice Address - Country:US
Practice Address - Phone:408-795-3600
Practice Address - Fax:408-971-6963
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN321848363LF0000X
CAMFC45774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q09656Medicare UPIN
BX917ZMedicare PIN
ZZZ28515ZMedicare ID - Type Unspecified