Provider Demographics
NPI:1861792863
Name:KESTLER, BRIANNE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:KESTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:6291 CENTER STREET
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604
Practice Address - Country:US
Practice Address - Phone:251-415-1496
Practice Address - Fax:251-415-1450
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA766363AS0400X
ALPA-766363A00000X
NC0010-02339363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
102I972632Medicare PIN