Provider Demographics
NPI:1568632800
Name:KACERGIS, EMILY-CORINNE (CNRP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY-CORINNE
Middle Name:
Last Name:KACERGIS
Suffix:
Gender:F
Credentials:CNRP
Other - Prefix:
Other - First Name:EMILY-CORINNE
Other - Middle Name:
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5127
Mailing Address - Country:US
Mailing Address - Phone:215-955-9195
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT STREET
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-955-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102884481Medicaid
PA320645Medicare PIN