Provider Demographics
NPI:1023377397
Name:KASALABA, KEMA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:KEMA
Middle Name:
Last Name:KASALABA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SW COAST HIGHWAY SUITE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5240
Mailing Address - Country:US
Mailing Address - Phone:541-265-8816
Mailing Address - Fax:541-265-3890
Practice Address - Street 1:1010 SW COAST HIGHWAY SUITE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5240
Practice Address - Country:US
Practice Address - Phone:541-265-8816
Practice Address - Fax:541-265-3890
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199800363LF0000X
FL9221193363LF0000X
MN3984363LF0000X
OR201405292NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily