Provider Demographics
NPI:1942772371
Name:KESNER, IAN
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:KESNER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RHETT
Other - Middle Name:IAN
Other - Last Name:KOESTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1832 N WALNUT RD TRLR 41
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6455
Mailing Address - Country:US
Mailing Address - Phone:702-439-1575
Mailing Address - Fax:
Practice Address - Street 1:1832 N WALNUT RD TRLR 41
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-6455
Practice Address - Country:US
Practice Address - Phone:702-439-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-25
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant