Provider Demographics
NPI:1578099263
Name:HESTER, KELSEY BERNADETTE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BERNADETTE
Last Name:HESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:BERNADETTE
Other - Last Name:KUEHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26777 LORAIN RD STE 417
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3224
Mailing Address - Country:US
Mailing Address - Phone:440-779-7292
Mailing Address - Fax:
Practice Address - Street 1:26777 LORAIN RD STE 417
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3224
Practice Address - Country:US
Practice Address - Phone:440-779-7292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.0253651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34 0715726OtherLOUIS STOKES VA MEDICAL CENTER