Provider Demographics
NPI:1962500256
Name:KERSEY, A. CELESTE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:A. CELESTE
Middle Name:
Last Name:KERSEY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32263 S KROPF RD
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-8563
Mailing Address - Country:US
Mailing Address - Phone:503-651-2627
Mailing Address - Fax:503-651-1205
Practice Address - Street 1:32263 S KROPF RD
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-8563
Practice Address - Country:US
Practice Address - Phone:503-651-2627
Practice Address - Fax:503-651-1205
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0618856223176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000432Medicaid