Provider Demographics
NPI:1093301301
Name:KESNER, TERRELLYN NOELLE
Entity Type:Individual
Prefix:
First Name:TERRELLYN
Middle Name:NOELLE
Last Name:KESNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S SHADY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6371
Mailing Address - Country:US
Mailing Address - Phone:304-359-6173
Mailing Address - Fax:304-788-0830
Practice Address - Street 1:87 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3218
Practice Address - Country:US
Practice Address - Phone:304-788-3897
Practice Address - Fax:304-788-0830
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty