Provider Demographics
NPI:1902431182
Name:KERSTIENS, MAKAYLA DANIELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MAKAYLA
Middle Name:DANIELLE
Last Name:KERSTIENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-8511
Mailing Address - Country:US
Mailing Address - Phone:256-815-3034
Mailing Address - Fax:
Practice Address - Street 1:1751 VETERANS DR STE 205
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4929
Practice Address - Country:US
Practice Address - Phone:256-767-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant