Provider Demographics
NPI:1124347752
Name:KESTERSON, BELINDA (PC-A)
Entity type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:PC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E WALNUT LAWN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-269-4450
Mailing Address - Fax:417-269-8333
Practice Address - Street 1:960 E WALNUT LAWN
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-4450
Practice Address - Fax:417-269-8333
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MO2005013494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant