Provider Demographics
NPI:1073594263
Name:KESTERSON, STACEY ANNE (RNC MSN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANNE
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:RNC MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N BELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1188
Mailing Address - Country:US
Mailing Address - Phone:865-471-2700
Mailing Address - Fax:865-471-2704
Practice Address - Street 1:305 N BELLWOOD RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1188
Practice Address - Country:US
Practice Address - Phone:865-471-2700
Practice Address - Fax:865-471-2704
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96945363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3349271Medicaid
TNP92743Medicare UPIN