Provider Demographics
NPI:1447214952
Name:HESTER, KEITH ROBERTSON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ROBERTSON
Last Name:HESTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2947
Mailing Address - Country:US
Mailing Address - Phone:352-357-4629
Mailing Address - Fax:352-357-9367
Practice Address - Street 1:1 W PARK AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2947
Practice Address - Country:US
Practice Address - Phone:352-357-4629
Practice Address - Fax:352-357-9367
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2246363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2448YOtherMEDICARE PTAN
FL290675900Medicaid
FLS78770Medicare UPIN