Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1363 | TX |
N | 222Z00000X | Podiatrist | 1363 | TX |
Y | 224P00000X | Prosthetist | 1363 | TX |
NPI | 1124378419 |
---|---|
Provider Name | Susan Kestner |
First Address | Austin, TX 78757-8401 |
Second Address | Austin, TX 78757-8401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 13/09/2012 |