Provider Demographics
NPI:1306042171
Name:KESTER, SHELBY L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:L
Last Name:KESTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:L
Other - Last Name:HUDACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2030 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-7790
Mailing Address - Country:US
Mailing Address - Phone:570-925-1034
Mailing Address - Fax:
Practice Address - Street 1:2030 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-7790
Practice Address - Country:US
Practice Address - Phone:570-925-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN253002L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA40-1523OtherWAIVER