Provider Demographics
NPI:1043782790
Name:PRESTIGE FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:PRESTIGE FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:540-877-6763
Mailing Address - Street 1:15 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3017
Mailing Address - Country:US
Mailing Address - Phone:301-697-5853
Mailing Address - Fax:304-822-2506
Practice Address - Street 1:15 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3017
Practice Address - Country:US
Practice Address - Phone:301-697-5853
Practice Address - Fax:304-822-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty