Basic Information
| Provider Information | |||||||||
| NPI: | 1700870078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTIESTEBAN | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 280 | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416530280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063498150 | ||||||||
| FaxNumber: | 6063498150 | ||||||||
| Practice Location | |||||||||
| Address1: | 842 E MOUNTAIN PKWY | ||||||||
| Address2: | |||||||||
| City: | SALYERSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063498100 | ||||||||
| FaxNumber: | 6063498150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2005 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 39452 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207V00000X | 39452 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 64101942 | 05 | KY | MEDICAID |