Provider Demographics
NPI:1891000170
Name:JESTER, KELLY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:JESTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 FOREST LOOP
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2640
Mailing Address - Country:US
Mailing Address - Phone:985-788-1385
Mailing Address - Fax:985-206-9766
Practice Address - Street 1:3916 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7306
Practice Address - Country:US
Practice Address - Phone:985-273-5099
Practice Address - Fax:985-206-9766
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1897400Medicaid