Provider Demographics
NPI:1508892779
Name:KERSTETTER, KATHLEEN (APN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:KERSTETTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6713
Mailing Address - Country:US
Mailing Address - Phone:609-441-8023
Mailing Address - Fax:609-441-8178
Practice Address - Street 1:314 CHRIS GAUPP DR STE 101
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4464
Practice Address - Country:US
Practice Address - Phone:609-748-5015
Practice Address - Fax:609-748-0303
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00105200363LA2100X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ109248CN9Medicare PIN