Provider Demographics
NPI:1205405644
Name:KACKER, ESHA (PMHNP)
Entity Type:Individual
Prefix:
First Name:ESHA
Middle Name:
Last Name:KACKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 BLUE BEACH CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6424
Mailing Address - Country:US
Mailing Address - Phone:512-632-7427
Mailing Address - Fax:
Practice Address - Street 1:1500 N HALSTED ST FL 234
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2517
Practice Address - Country:US
Practice Address - Phone:516-407-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.509746163W00000X
TX916707163W00000X
IL209.023336363L00000X, 363LP0808X
TX1035252363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner