Provider Demographics
NPI:1568844702
Name:KESTY, KENDRA (MD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:KESTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 JONATHAN LUCAS ST
Mailing Address - Street 2:634
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 HANESTOWN CT STE 151
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1749
Practice Address - Country:US
Practice Address - Phone:336-765-9350
Practice Address - Fax:336-760-4255
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01603207V00000X
SC38544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty