Basic Information
Provider Information
NPI: 1083712707
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KESLER
FirstName: ARCHIE
MiddleName: DEAN
NamePrefix: DR.
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2817 REILLY ROAD MCXC COD CREDENTIALS
Address2: WOMACK ARMY MEDICAL CENTER
City: FORT BRAGG
State: NC
PostalCode: 28310
CountryCode: US
TelephoneNumber: 9109078922
FaxNumber: 9109076069
Practice Location
Address1: 2817 REILLY RD OB GYN CLINIC
Address2: WOMACK ARMY MEDICAL CENTER
City: FORT BRAGG
State: NC
PostalCode: 28310
CountryCode: US
TelephoneNumber: 9109076881
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/20/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X17776NCY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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