Provider Demographics
NPI:1407161383
Name:TESTER, KERRY A (IDC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:TESTER
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDC
Mailing Address - Street 1:108 SANDA AVE BLDG 564
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5830
Mailing Address - Country:US
Mailing Address - Phone:757-887-7312
Mailing Address - Fax:757-887-7438
Practice Address - Street 1:108 SANDA AVE BLDG 564
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5830
Practice Address - Country:US
Practice Address - Phone:757-887-7312
Practice Address - Fax:757-887-7438
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman