Provider Demographics
NPI:1508484544
Name:KASHETA, ALYSSA MARY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARY
Last Name:KASHETA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 FREEMAN RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-7986
Mailing Address - Country:US
Mailing Address - Phone:570-575-9077
Mailing Address - Fax:
Practice Address - Street 1:103 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1149
Practice Address - Country:US
Practice Address - Phone:570-576-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN673109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty