Provider Demographics
NPI:1497820237
Name:KAESS, KATHLEEN S (MSN, APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:KAESS
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 S BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4141
Mailing Address - Country:US
Mailing Address - Phone:302-736-6135
Mailing Address - Fax:
Practice Address - Street 1:1059 S BRADFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4141
Practice Address - Country:US
Practice Address - Phone:302-736-6135
Practice Address - Fax:302-736-0172
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000109363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030386Medicaid
DE006697V39Medicare PIN