Individual
DAVID R KESTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
525 SAINT MARY ST, THIBODAUX, LA 70301-2627
(985) 446-6284
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 446-6284
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
302525
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2423410
—
LA
Enumeration date
06/16/2016
Last updated
07/26/2016
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