Individual
MR. ZACHARY M KERSTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
634 E BEAR BLVD APT 309, SPRINGFIELD, MO 65806-3821
(618) 980-9310
Mailing address
634 E BEAR BLVD APT 309, SPRINGFIELD, MO 65806-3821
(618) 980-9310
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
TRICARE
—
Enumeration date
01/28/2019
Last updated
01/28/2019
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