Provider Demographics
NPI:1083113047
Name:BARTHELEMY, KASSANDRA (NP)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BARTHELEMY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 TEESDALE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3902
Mailing Address - Country:US
Mailing Address - Phone:267-431-5305
Mailing Address - Fax:
Practice Address - Street 1:8118 OLD YORK RD
Practice Address - Street 2:SUITE D
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-635-3151
Practice Address - Fax:215-635-3165
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAG01180040364SG0600X
PASP018713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner