Provider Demographics
NPI:1871645291
Name:KESTERSON, JENNIFER L (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1251 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1643
Mailing Address - Country:US
Mailing Address - Phone:717-867-4671
Mailing Address - Fax:717-867-4981
Practice Address - Street 1:1251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1643
Practice Address - Country:US
Practice Address - Phone:717-867-4671
Practice Address - Fax:717-867-4981
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014083363LA2200X
KY3442P363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103051570Medicaid
KY78007895Medicaid
IN200383420Medicaid
KY78007895Medicaid
IN200383420Medicaid
PA389088Medicare PIN