Provider Demographics
NPI:1437243227
Name:KESLER, MICHAEL G (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:KESLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1553
Mailing Address - Country:US
Mailing Address - Phone:270-274-0480
Mailing Address - Fax:270-274-0482
Practice Address - Street 1:225 MEDICAL CENTER DR STE 405
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001559367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000604457OtherANTHEM BCBS
KY74004649Medicaid
R60913Medicare UPIN
KY000000604457OtherANTHEM BCBS