Provider Demographics
NPI:1023888088
Name:NESTY, KAITLIN BREANNE (OD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:BREANNE
Last Name:NESTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8125 HENDERSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-7205
Mailing Address - Country:US
Mailing Address - Phone:765-318-1799
Mailing Address - Fax:
Practice Address - Street 1:3310 PROFESSIONAL PARK STE 101
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2497
Practice Address - Country:US
Practice Address - Phone:270-683-2101
Practice Address - Fax:270-683-2507
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN18004461A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist