Provider Demographics
NPI:1518396704
Name:KETLER, CASSANDRA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYNN
Last Name:KETLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:LYNN
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:847 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-337-8762
Mailing Address - Fax:814-337-4462
Practice Address - Street 1:847 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-337-8762
Practice Address - Fax:814-337-4462
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056471363A00000X
PAOA003147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant