Provider Demographics
NPI:1114055472
Name:KESLER, AUDREY (CNA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:KESLER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ATLANTIC AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-2304
Mailing Address - Country:US
Mailing Address - Phone:757-851-4039
Mailing Address - Fax:
Practice Address - Street 1:111 ATLANTIC AVE UNIT B
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-2304
Practice Address - Country:US
Practice Address - Phone:757-851-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401110429251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health