Provider Demographics
NPI:1700870078
Name:SANTIESTEBAN, JOANNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:L
Last Name:SANTIESTEBAN
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0280
Mailing Address - Country:US
Mailing Address - Phone:606-349-8150
Mailing Address - Fax:606-349-8150
Practice Address - Street 1:842 E MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465
Practice Address - Country:US
Practice Address - Phone:606-349-8100
Practice Address - Fax:606-349-8150
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39452207RA0401X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64101942Medicaid
KY0667810Medicare ID - Type Unspecified
KY0258135Medicare ID - Type Unspecified
KY0396129Medicare ID - Type Unspecified
KYK030871Medicare PIN
KY0253442Medicare ID - Type Unspecified
KY64101942Medicaid