Provider Demographics
NPI:1083681639
Name:HASSE, KATHLEEN T (RN CS FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:HASSE
Suffix:
Gender:F
Credentials:RN CS FNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-9327
Mailing Address - Country:US
Mailing Address - Phone:304-422-8112
Mailing Address - Fax:304-422-3924
Practice Address - Street 1:2675 36TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8024
Practice Address - Country:US
Practice Address - Phone:304-422-8112
Practice Address - Fax:304-422-3924
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27651363LF0000X
OHNP06495363LF0000X
OHRN283452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721120OtherMSBCBS
WV7102090000Medicaid
500017684OtherRR MEDICARE
WV7102090000Medicaid
500017684OtherRR MEDICARE
OHNP06863Medicare PIN