Provider Demographics
NPI:1770541013
Name:KESTER, NATHAN L (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:L
Last Name:KESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6565
Mailing Address - Country:US
Mailing Address - Phone:417-877-0624
Mailing Address - Fax:417-851-5080
Practice Address - Street 1:3801 S NATIONAL AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43089-0202085R0202X
MOR1J522085R0202X, 2085N0904X
WA229182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3416014OtherCIGNA
P00003785OtherRR MEDICARE
ARP00894334OtherRR MEDICARE
AR178031001Medicaid
MO203076369Medicaid
125353000OtherUS DEPT. OF LABOR
MO1770541013Medicaid
MO1770541013Medicaid
MO030050115Medicare PIN
AR5H366G073Medicare PIN
ARP00894334OtherRR MEDICARE
3416014OtherCIGNA