Individual
BRADY JAMES KESTERHOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2315 MYRTLE ST STE L90, ERIE, PA 16502-4607
(814) 452-7575
Mailing address
2315 MYRTLE ST STE L90, ERIE, PA 16502-4607
(814) 452-7575
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA065538P
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16238066
CAQH
—
Enumeration date
06/11/2024
Last updated
06/27/2024
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