Active NPI
John Judson Kersbergen, PHARMACIST
- Pharmacist
- Poplar Bluff, MO
National Provider Identifier
1093031841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2003029273
- Practice address
- 2233 N Westwood Blvd
Poplar Bluff, MO 63901-2332 - Phone
- (573) 785-4557
- Fax
- (573) 686-0970
- NPI assigned
- Apr 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2003029273 | MO | Primary |
Addresses
Primary practice location
2233 N Westwood Blvd
Poplar Bluff, MO 63901-2332
Mailing address
2233 N Westwood Blvd
Poplar Bluff, MO 63901-2332
Phone (573) 785-4557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2003029273 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1093031841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2233 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639012332",
"telephone_number": "573-785-4557",
"fax_number": "573-686-0970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2233 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639012332",
"telephone_number": "573-785-4557",
"fax_number": "573-686-0970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERSBERGEN",
"first_name": "JOHN",
"middle_name": "JUDSON",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-19",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2003029273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.