Provider Demographics
NPI:1275292013
Name:KATES, JESSICA ATIYA (CNA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ATIYA
Last Name:KATES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 FOUR MILE DR APT 12
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1963
Mailing Address - Country:US
Mailing Address - Phone:717-660-3306
Mailing Address - Fax:
Practice Address - Street 1:1735 FOUR MILE DR APT 12
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1963
Practice Address - Country:US
Practice Address - Phone:717-660-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10025234376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty