Provider Demographics
NPI:1487633863
Name:CASSEDAY, KATHLEEN A (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CASSEDAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1309
Mailing Address - Country:US
Mailing Address - Phone:509-382-4510
Mailing Address - Fax:509-382-2508
Practice Address - Street 1:112 N 2ND ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-1309
Practice Address - Country:US
Practice Address - Phone:509-382-4510
Practice Address - Fax:509-382-2508
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9600727Medicaid